RULE 067.00.12-001 - Revisions to Rules: Chapter 1 - General Provisions; Chapter 2 - Licensure: Chapter 3 - Registered Nurse Practitioner; and Chapter 6 - Standards for Nursing Education Programs; the Nurse Practice Act, Article 8 and Chapter 4 - Advanced Practice

RULE 067.00.12-001. Revisions to Rules: Chapter 1 - General Provisions; Chapter 2 - Licensure: Chapter 3 - Registered Nurse Practitioner; and Chapter 6 - Standards for Nursing Education Programs; the Nurse Practice Act, Article 8 and Chapter 4 - Advanced Practice

CHAPTER ONE GENERAL PROVISIONS

SECTION I PURPOSE AND AUTHORITY

A. PURPOSE

1. ARKANSAS NURSE PRACTICE ACT - Requires that any person who practices or offers to practice professional nursing, advanced practice nursing, registered nurse practitioner nursing, practical nursing, or psychiatric technician nursing for compensation be licensed and submit evidence that he or she is qualified to so practice and shall be licensed as hereinafter provided.

2. ARKANSAS STATE BOARD OF NURSING - Established by the Arkansas Nurse Practice Act for the implementation of the statute by carrying on the licensing or certification, disciplinary, and educational functions for professional, advanced practice, registered nurse practitioner, practical, and psychiatric technician nursing and medication assistants.

B. LEGAL AUTHORITY - The authority of the Board is contained in the ACA § 17-87-101 et seq.

SECTION II THE PRACTICE OF NURSING

A. THE PRACTICE OF PROFESSIONAL NURSING

The performance for compensation of any acts involving the observation, care, and counsel of the ill, injured, or infirm; the maintenance of health or prevention of illness of others; the supervision and teaching of other personnel; the delegation of certain nursing practices to other personnel as set forth in rules established by the board; or the administration of medications and treatments as prescribed by practitioners authorized to prescribe and treat according to state law where such acts require substantial specialized judgment and skill based on knowledge and application of the principles of biological, physical, and social sciences.

B. THE PRACTICE OF ADVANCED PRACTICE REGISTERED NURSING

The practice of advanced practice registered nursing means the delivery of health care services for compensation by professional nurses who have gained additional knowledge and skills through successful completion of an organized program of nursing education that certifies nurses for advanced practice roles as certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and clinical nurse specialists.

1. CERTIFIED NURSE PRACTITIONER - The practice of certified nurse practitioner nursing means the performance for compensation of nursing skills by a registered nurse who, as demonstrated by national certification, has advanced knowledge and practice skill in the delivery of nursing services.

2. CERTIFIED REGISTERED NURSE ANESTHETIST - The practice of certified registered nurse anesthesia means the performance for compensation of advanced nursing skills relevant to the administration of anesthetics under the supervision of, but not necessarily in the presence of, a licensed physician, licensed dentist, or other person lawfully entitled to order anesthesia.

3. CERTIFIED NURSE MIDWIFE - The practice of nurse midwifery means the performance for compensation of nursing skills relevant to the management of women's health care, focusing on pregnancy, childbirth, the postpartum period, care of the newborn, family planning, and gynecological needs of women, within a health care system that provides for consultation, collaborative management, or referral as indicated by the health status of the client.

4. CLINICAL NURSE SPECIALIST - The practice of clinical nurse specialist nursing means the performance for compensation of nursing skills by a registered nurse who, through study and supervised practice at the graduate level and as evidenced by national certification, has advanced knowledge and practice skills in a specialized area of nursing practice.

C. THE PRACTICE OF REGISTERED NURSE PRACTITIONER NURSING

The delivery of health care services for compensation in collaboration with and under the direction of a licensed physician or under the direction of protocols developed with a licensed physician. Registered nurse practitioners shall be authorized to engage in activities as recognized by the nursing profession and as authorized by the Board. Nothing in this subdivision is to be deemed to limit a registered nurse practitioner from engaging in those activities which normally constitute the practice of nursing, or those which may be performed by persons without the necessity of the license to practice medicine.

D. THE PRACTICE OF PRACTICAL NURSING

The performance for compensation of acts involving the care of the ill, injured, or infirm or the delegation of certain nursing practices to other personnel as set forth in rules established by the board; under the direction of a registered professional nurse, an advanced practice nurse, a licensed physician, or a licensed dentist, which acts do not require the substantial specialized skill, judgment, and knowledge required in professional nursing.

E. THE PRACTICE OF PSYCHIATRIC TECHNICIAN NURSING

The performance for compensation of acts involving the care of the physically and mentally ill, retarded, injured, or infirm or the delegation of certain nursing practices to other personnel as set forth in rules established by the board, and the carrying out of medical orders under the direction of a registered professional nurse, an advanced practice nurse, a licensed physician or a licensed dentist, where such activities do not require the substantial specialized skill, judgment, and knowledge required in professional nursing.

SECTION III IDENTIFICATION INSIGNIA

A. Any person who holds a license to practice nursing in this state shall use the legal title or the abbreviation as set forth in Arkansas Code Annotated Section 17-87-101, et. seq. No other person shall assume any other name, title, or abbreviation or any words, letters, signs, or devices that would cause a reasonable person to believe the user is licensed to practice nursing.

B. Any person licensed to practice nursing shall wear an insignia to identify himself by his name and appropriate legal title or abbreviation during times when such person is providing health care to the public for compensation.

C. The insignia shall be prominently displayed and clearly legible such that the person receiving care may readily identify the type of nursing personnel providing such care.

SECTION IV DEFINITION OF TERMS

ACCREDITED - The status granted by an accrediting agency through a voluntary process.

ACTIVE PRACTICE - The act of performing for compensation those acts within specified scope of practice and authorized by the board.

ACTIVITIES OF DAILY LIVING - Those self-care activities which must be accomplished each day in order for the client to care for his own needs and participate in society.

ADVANCED PRACTICE REGISTERED NURSE CATEGORIES - Certified nurse practitioner, certified registered nurse anesthetist, certified nurse midwife, and clinical nurse specialist.

APPROVAL - Recognized by the Board as meeting the education standards for preparing graduates for registered or practical nurse licensure.

APPROVAL TYPES:

PREREQUISITE - Status authorizing a program to proceed in establishing a program of nursing.

INITIAL - Status awarded to a program that has met all initial requirements and authorizes the program to proceed to admission of students and completion of educational standards.

FULL - Status awarded to a program that has met all educational standards.

CONTINUED FULL - Status awarded to a program that continues to maintain the educational standards.

CONDITIONAL - Status of a program that has not maintained the educational standards. Serves as a warning that if the standards are not followed withdrawal of approval may be initiated.

BOARD - The Arkansas State Board of Nursing.

BOARD REPRESENTATIVE - A person appointed, hired, or otherwise authorized by the Board to carry out its functions.

CLINICAL EXPERIENCE- a faculty planned and guided learning activity that is designed to support students in meeting identified programs educational and course outcomes. The clinical settings include a variety of clinical of clinical practice settings or affiliating agencies, including but not limited to:

ACUTE CARE SETTING- A hospital based clinical site where students provide direct patient care and associated clinical conferences.

NON- ACUTE CARE SETTING- A long term, extended care, or nursing home based clinical site where students provide direct patient care and associated clinical conferences.

COMMUNITY SETTING- Community partner experiences with nurses and or professional staff in settings other than acute and non - acute settings where students provide indirect direct patient care and associated clinical conferences.

CLINICAL FACILITY - A facility outside the framework of the program which provides educational experiences for the student.

COLLABORATING PHYSICIAN - A physician, licensed under the Arkansas Medical Practices Act, § 17 -93 -201 et seq., who has a practice comparable in scope, specialty or expertise to that of the advanced practice nurse or registered nurse practitioner.

COLLABORATIVE PRACTICE AGREEMENT - Document setting out how an advanced practice nurse and physician intend to cooperate in the delivery of client care.

CONSULTING PHYSICIAN - A physician licensed by the Arkansas Medical Practices Act who has obstetric privileges in a hospital.

CONTACT HOUR- A measurement for continuing education; either a 50 or 60 minute clock hour of continuing education.

CONTINUING EDUCATION UNIT (CEID- A measurement for continuing education; one CEU equals ten (10) contact hours.

CONTROLLED SUBSTANCE - Drug substance or immediate precursor in Schedules I-V.

CREDENTIAL - A license, certificate, or other evidence of qualifications.

DELEGATION - Entrusting the performance of a selected nursing task to an individual who is qualified, competent, and able to perform such tasks. The nurse retains the accountability for the total nursing care of the individual.

DISTANT LEARNING SITE - A location separate from the main campus where course offerings are delivered.

DOCUMENTATION - Written proof or evidence to substantiate factual claims or statements satisfactory to the Board.

DRUG SAMPLE - A unit of a legend drug which is distributed to a practitioner by a manufacturer or a manufacturer's representative at no charge, is not intended to be sold, and is intended to promote the sale of the drug.

EMERGENCY CARE - Unanticipated care provided to a person who is unconscious, ill, or injured, when the circumstances require prompt decisions and actions, and when the necessity of immediate care is so apparent that any delay would seriously worsen the physical condition or endanger the life of the person.

GRADUATE COMPETENCIES - Educational outcomes expected of the nursing program's graduates.

LEGEND DRUG - A drug limited by Section 503(b)(1) of the Federal Food, Drug, and Cosmetic Act to being dispensed by or upon a practitioner's prescription.

MAY - Indicates permission.

MISSION - Beliefs accepted by the parent institution for the framework of the school's programs and offerings.

OBSERVATIONAL EXPERIENCE - One in which the nursing student provides no nursing care.

PRACTICE- FOCUSED- Academic study or continuing education targeted to meet the needs of the nurse in his / her nursing practice role.

PARENT INSTITUTION - The official institution sponsoring the nursing program.

PERSONAL CARE - Assistance with activities of daily living not requiring a medical prescription.

PHILOSOPHY - Beliefs adopted by the nursing faculty for the framework of the program.

PRECEPTOR - A currently licensed nurse or physician, meeting the requirements of these rules, who serves as a facilitator of student learning in a practice setting.

PRECEPTORSHIP - Practice under the supervision of a qualified preceptor in the care of consumers of health services while a student in a Board approved program.

PRESCRIPTIVE AUTHORITY - Authorization, given by the Board, for an advanced practice nurse who meets established requirements to prescribe. Prescriptive authority for controlled substances shall only extend to drugs listed in Schedules III through V.

PROGRAM - The total educational curriculum in nursing, including theoretical and clinical components. Types of Programs are:

ASSOCIATE DEGREE PROGRAM - A professional nursing program leading to an associate degree with a major in nursing.

BACCALAUREATE DEGREE PROGRAM - A professional nursing program leading to a baccalaureate degree with a major in nursing.

DD7LOMA PROGRAM - A professional nursing program leading to a diploma with a major in nursing.

PRACTICAL NURSING PROGRAM - A nursing program leading to a certificate in practical nursing.

PSYCHIATRIC TECHNICIAN NURSING PROGRAM - A nursing program leading to a certificate in psychiatric technician nursing.

PROGRAM DIRECTOR - The person responsible for the specific educational unit in nursing, regardless of the official title in the institution.

PROTOCOL - A written statement which delineates agreed-upon approaches in client care and management.

REFRESHER COURSE- A formal course of instruction designed to provide a review and update of nursing theory and practice.

SATELLITE CAMPUS - A separate geographic location where a program is offered which has a separate student body and a separate faculty leader/coordinator and/or faculty.

SHALL, WILL, MUST - Indicates a mandatory requirement.

SHOULD - Indicates a recommendation.

SURVEY - A visit to determine compliance with minimum requirements.

THERAPEUTIC DEVICE - An instrument or apparatus, requiring a prescription, that is intended for use in diagnosis or treatment, and in the prevention of disease or maintenance or restoration of health.

TRANSMITTING - Relaying an order for a medication, treatment, or therapeutic device.

UNDER THE DIRECTION OF A LICENSED PHYSICIAN - The performance of specific acts and procedures which have been authorized by a licensed physician and which may be performed outside the presence of the physician under conditions where a physician is readily available for consultation.

UNENCUMBERED LICENSE - Free of disciplinary limitations or pending action.

SECTION V GENERAL MATTERS

A. OFFICE AND HOURS

The office of the Board is in Little Rock, Arkansas. The office shall be open during business hours each day; Saturday, Sunday, and holidays excepted.

B. EXAMINATION, INQUIRY, OR INVESTIGATION

The Board may, through one or more of its members, or staff especially authorized, conduct at its office in Little Rock, Arkansas, or in any part of the state, any examination, inquiry or investigation, hearing, or other proceeding necessary to perform its duties and functions. The executive director shall have custody of the seal and official records and shall be responsible for the maintenance and custody of the files and records of the Board, including the credentials for all Arkansas licensed nurses, transcripts of testimony and exhibits, the minutes of all actions taken by the Board and all of its findings, determinations, reports, opinions, orders, rules, and approved forms.

C. AUTHENTICATION

All notices and other actions of the Board shall be authenticated or signed by the president, secretary, or such other person as may be authorized by the Board.

D. NOTICE

Upon order of the Board, the president, secretary, or executive director shall issue all notices of hearings and other process as may be directed by the Board.

E. EXECUTIVE DIRECTOR

The executive director of the Board shall be a registered nurse and meet the qualifications required by the Board.

F. BOARD FUNDS AND FEES

1. The Board shall establish and collect fees for services relating to examination, licensing, endorsement, certification for prescriptive authority, temporary permits, license renewal, and other reasonable services as determined by the Board.

2. All funds received by the Board shall be deposited in the State Treasury to the credit of the Board.

3. Fees paid to the Board may be in the form of cash cashier checks, or money orders. Personal checks for initial licensure are accepted from in-state residents only.

4. Fees paid to the Board are processing fees and are not refundable.

G. RECORDS

1. Record Maintenance

The executive director shall enter, in permanent form, credentials of all nurses, records of official transactions and proceedings, and keep such records in safekeeping.

2. Tapes

Meetings may be taped by a secretary as necessary for purposes of minute taking. Tapes may be erased after corresponding minutes have been approved.

3. Destruction

The executive director may destroy or dispose of records in the office in accord with applicable law.

4. Certified Copies

Upon written request and payment of a fee, the executive director shall provide to any nurse holding Arkansas licensure a certified copy of any of his or her records on file in the Board office.

5. Public Inspection

Records shall be open to public inspection except as may be specifically exempted by statute.

6. Request for Copies of Rules

Copies of rules of the Board will be furnished free of charge to any official of a government agency requesting them in the performance of his or her duties.

H. EXAMINATION REVIEW

A registered nurse, practical nurse, or psychiatric technician nurse candidate who has failed the licensure examination may review his or her examination and/or challenge examination items according to the policies and procedures of the test development vendor.

SECTION VI FAITH A. FIELDS NURSING SCHOLARSHIP/LOAN PROGRAM

A ELIGIBILITY REQUIREMENTS

As funds are made available, any Arkansas resident who is enrolled in, or has been accepted for admission to, an approved school of nursing in this state or in a nationally accredited school outside the state, in a course of study leading to qualification as a registered nurse, licensed practical nurse, or nurse educator shall be eligible to make application to the Arkansas State Board of Nursing for a nursing educator loan or a nursing practice loan. The Board may, depending upon available funds, make a nursing educator loan or a nursing practice loan to an applicant when it determines that the applicant:

1. Warrants financial assistance to complete his or her nursing studies.

2. Has signed a written agreement to, upon graduation and licensure and for one year for each year a loan is granted:

a. Teach in a nursing education program in the State of Arkansas if granted a nursing educator loan; or

b. Engage in practice as a registered nurse or licensed practical nurse in the State of Arkansas if granted a nursing practice loan; and

c. Repay each loan with interest at the maximum legal rate if the applicant fails to fulfill the requirements of the board.

B. MAINTENANCE REQUIREMENTS

1. Subject to the availability of funds and the limits set out in these rules, each loan made to an applicant shall be renewable annually for the number of years required to complete studies leading to qualification as a registered nurse, license practical nurse, or nursing educator.

2. Any loan made to an applicant subsequent to an initial loan shall be made only upon application of the recipient and upon finding by the Arkansas State Board of Nursing that the applicant:

a. Has successfully completed the nursing studies of the preceding academic year and remains in good standing as an enrolled student in the appropriate nursing program;

b. Warrants financial assistance to complete his or her nursing studies;

c. Has signed a written agreement to, upon graduation and licensure and for one year for each year a loan is granted:

i. Teach in a nursing education program in the State of Arkansas; or

ii. Engage in practice as a registered nurse or licensed practical nurse in the State of Arkansas; and

iii. Repay each loan with interest at the maximum legal rate if the applicant fails to fulfill the requirements of the board; and

d. Continues to be a lawful resident of the State of Arkansas.

3. The total of the loans made to any one (1) student shall not exceed twenty thousand dollars ($20,000).

C. BORROWER'S LOSS OF GOOD STANDING

If the recipient of a loan ceases to be enrolled in good standing in a recognized nursing program before completing the education requirements to qualify as a registered nurse, licensed practical nurse, or nursing educator, the principal and interest of all loans made to the recipient shall become due and payable immediately or as provided in the loan agreement.

D. LOAN REPAYMENT

1. A recipient of a loan shall repay each loan together with interest at the maximum rate allowed by Arkansas law if the recipient:

a. Ceases to be enrolled in good standing in a recognized nursing program before completing the education requirements to qualify as a registered nurse, licensed practical nurse, or nursing educator;

b. Does not, for the period specified in the agreement, teach in an Arkansas nursing education program if granted a nursing educator loan, or engage in practice as a registered nurse or licensed practical nurse in Arkansas if granted a nursing practice loan; or

c. Fails to comply with any other requirements of the agreement.

2. Interest shall accrue from the date each payment of funds was received by the recipient.

3. No interest shall accrue and no obligation to repay a loan exists during any period of time that the recipient of the loan serves on active duty in the United States armed forces.

4. If repayment of a loan is required, upon the death of the recipient of the loan all unpaid principal and interest is due and payable.

5. The failure to repay a loan as specified may be considered unprofessional conduct for disciplinary purposes.

CHAPTER TWO LICENSURE: RN, LPN, AND LPTN

SECTION I QUALIFICATIONS

A. Good moral character.

B. Completion of an approved high school course of study or the equivalent as determined by the appropriate educational agency.

C. Completion of the required approved nursing education program. (LPN and LPTN requirements may be waived if applicant is determined to be otherwise qualified.)

D. The Arkansas State Board of Nursing (ASBN) may refuse to admit to the examination any candidate and refuse to issue a license, certificate, or registration to any applicant if the license, practice privilege, certificate, or registration of such person has been revoked or suspended or placed on probation and not reinstated by the jurisdiction which took such action.

E. Effective January 1,2000, no person shall be eligible to receive or hold a license issued by the Board if that person has pleaded guilty or nolo contendere to, or been found guilty by any court in the State of Arkansas, or of any similar offense by a court in another state, or of any similar offense by a federal court of any offense listed in ACA § 17-87-312.

SECTION II EXAMINATION

A. ELIGIBILITY

The applicant shall meet the licensure requirements of the Board.

B. APPLICATION

1. Applications for examination shall be completed and filed with the Board prior to the examination.

2. Examination applications shall not be acceptable if the director or chairman of an educational program has certified the applicant prior to date of completion.

3. Applicants for licensure by examination shall not be deemed eligible to take the licensure examination until such time that the results of the state and federal criminal background checks have been received.

C. FEE

1. The examination fee shall accompany the application.

2. The examination fee (first time or retake) is not refundable.

3. The fees for the state and federal criminal background checks are the responsibility of the applicant and shall be submitted to the Arkansas State Board of Nursing with the application for same.

4. The fees are determined by the Arkansas State Police and the FBI and are not refundable.

D. PASSING SCORE

The passing score on the licensure examination shall be determined by the Board.

E. FAILING SCORE AND ELIGIBILITY TO RETAKE THE EXAMINATION

1. Any applicant whose score falls below the passing score shall fail the examination.

2. Persons failing the examination will be responsible for preparing to retake the examination.

3. The frequency and number of retests by unsuccessful candidates shall be determined by the Board.

4. Applicants retaking the examination shall have state and federal criminal background checks within the past twelve months on file with the Board.

F. RESULTS

1. Examination results shall not be released until the applicant's transcript is received from the school.

2. Examination results shall be mailed to all applicants and to their respective schools.

G. INTERNATIONALLY EDUCATED NURSES

1. The applicant must present evidence of:

a. Graduation from an approved or accredited school of nursing. The Board may waive this requirement for LPN and LPTN applicants provided they are otherwise qualified.

b. Licensure or proof of eligibility for licensure in the country of graduation.

c. Theory and practice in medical, surgical, pediatric, obstetric, and psychiatric nursing which is substantially similar in length and content to that in equivalent Arkansas Board approved nursing programs at the time of application as verified by a credentials review agency.

d. State and federal criminal background checks within the past twelve months on file with the Board.

e. Credentials review that includes verification of the candidate's education, training, experience, and licensure with respect to the statutory and regulatory requirements for the nursing profession, as well as oral and written competence in English.

2. Transcripts and certificates which are not in English must be accompanied by a certified translation.

3. Applicants shall be required to take such licensure examinations as required of Arkansas Board approved nursing programs.

H. EQUIVALENCIES

1. LPTN to LPN: Candidates holding LPTN licensure who completed Arkansas Board approved LPTN programs after March 18, 1980, may be admitted to the LPN licensure examination provided they are otherwise qualified.

2. RN examination failures: Graduates of Board approved RN programs, upon submission of an official transcript directly from the school, and a copy of their RN examination failure results, may be admitted to the PN licensure examination provided they are otherwise qualified.

3. Portion of RN Program: Candidates who have completed equivalent courses in a state approved program of nursing may be admitted to the PN licensure examination provided they are otherwise qualified. Evidence must be provided verifying successful completion of classroom instruction and clinical practice substantially similar to the minimum requirements for practical nursing programs.

SECTION III INTERSTATE NURSE LICENSURE COMPACT

A. DEFINITIONS OF TERMS IN THE COMPACT

For the purpose of the Compact:

1. "Board" means party state's regulatory body responsible for issuing nurse licenses.

2. "Information system" means the coordinated licensure information system.

3. "Primary state of residence" means the state of a person's declared fixed permanent and principal home for legal purposes; domicile.

4. "Public" means any individual or entity other than designated staff or representatives of party state Boards or the National Council of State Boards of Nursing, Inc.

5. "Alternative program" means a voluntary, non-disciplinary monitoring program approved by a nurse licensing board.

6. "Coordinated Licensure Information System" means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws, which is administered by a non-profit organization composed of state nurse licensing boards.

7. "Home state" means the party state which is the nurse's primary state of residence.

8. "Multi-state licensure privilege" means current, official authority from a remote state permitting the practice of nursing as either a registered nurse or a licensed practical/vocational nurse in such party state.

9. "Nurse" means a registered nurse or licensed practical nurse, as those terms are defined by each party's state practice laws.

10. "Party state" means any state that has adopted this Compact.

11. "Remote state" means a party state, other than the home state,

(a) where the patient is located at the time nursing care is provided, or,

(b) in the case of the practice of nursing not involving a patient, in such party state where the recipient of nursing practice is located.

12. "Current significant investigative information" means:

(a) investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or

(b) investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.

13. Licensed Practical Nurse or Licensed Vocational Nurse means a person who has been licensed as an LPN or LVN by a party state licensing board.

Other terms used in these rules are to be defined as in the Interstate Compact.

B. ISSUANCE OF A LICENSE BY A COMPACT PARTY STATE

For the purpose of this Compact:

1. No applicant for initial licensure will be issued a compact license granting a multi-state privilege to practice unless the applicant first obtains a passing score on the applicable NCLEX examination or any other predecessor examination used for licensure.

2. A nurse applying for a license in a home party state shall produce evidence of the nurses' primary state of residence. Such evidence shall include a declaration signed by the licensee. Further evidence that may be requested may include but is not limited to:

a. Driver's license with a home address;

b. Voter registration card displaying a home address;

c. Federal income tax return declaring the primary state of residence;

d. Military form No. 2058-state of legal residence certificate; or

e. W2 from US Government or any bureau, division or agency thereof indicating the declared state of residence.

3. A nurse on a visa from another country applying for licensure in a party state may declare either the country of origin or the party state as the primary state of residence. If the foreign country is declared the primary state of residence, a single state license will be issued by the party state.

4. A license issued by a party state is valid for practice in all other party states unless clearly designated as valid only in the state which issued the license.

5. When a party state issues a license authorizing practice only in that state and not authorizing practice in other party states (i.e. single state license), the license information shall clearly indicate that it is valid only in the state of issuance.

6. A nurse changing primary state of residence, from one party state to another party state, may continue to practice under the former home state license and multistate licensure privilege during the processing of the nurse's licensure application in the new home state for a period not to exceed thirty (30) days.

7. The licensure application in the new home state of a nurse under pending investigation by the former home state shall be held in abeyance and the thirty (30) day period in section B.6. shall be stayed until resolution of the pending investigation.

8. The former home state license shall no longer be valid upon the issuance of a new home state license.

9. If a decision is made by the new home state denying licensure, the new home state shall notify the former home state within ten (10) business days and the former home state may take action in accordance with that state's laws and rules.

10. Party states shall recognize and honor either the LPN or LVN title used for Licensed Practical Nurses and Licensed Vocational Nurses, respectively.

C. LIMITATIONS ON MULTISTATE LICENSURE PRIVILEGE-DISCIPLINE

1. Home state Boards shall include in all licensure disciplinary orders and/or agreements that limit practice and/or require monitoring the requirement that the licensee subject to said order and/or agreement will agree to limit the licensee's practice to the home state during the pendency of the disciplinary order and/or agreement. This requirement may, in the alternative, allow the nurse to practice in other party states with prior written authorization from both the home state and such other party state Boards.

2. An individual who had a license which was surrendered, revoked, suspended, or an application denied for cause in a prior state of primary residence, may be issued a single state license in a new primary state of residence until such time as the individual would be eligible for an unrestricted license by the prior state(s) adverse action. Once eligible for licensure in the prior state(s), a multistate license may be issued.

D. INFORMATION SYSTEM

1. Levels of access

a. The public shall have access to nurse licensure information limited to:

(1) The nurse's name;

(2) Jurisdiction(s) of licensure;

(3) License expiration date(s);

(4) Licensure classification(s) and status(es);

(5) Public emergency and final disciplinary actions, as defined by contributing state authority; and

(6) The status of multistate licensure privileges.

b. Non-party state Boards shall have access to all Information System data except current significant investigative information and other information as limited by contributing party state authority.

c. Party state Boards shall have access to all Information System data contributed by the party states and other information as limited by contributing non-party state authority.

2. The licensee may request in writing to the home state Board to review the data relating to the licensee in the Information System. In the event a licensee asserts that any data relating to him or her is inaccurate, the burden of proof shall be upon the licensee to provide evidence that substantiates such claim. The Board shall verify and within ten (10) business days correct inaccurate data to the Information System.

3. The Board shall report to the Information System within ten (10) business days:

a. Disciplinary action, agreement, or order requiring participation in alternative programs or which limit practice or require monitoring (except agreements and orders relating to participation in alternative programs required to remain nonpublic by contributing state authority);

b. Dismissal of complaint, and

c. Changes in status of disciplinary action, or licensure encumbrance.

4. Current significant investigative information shall be deleted from the Information System within ten (10) business days upon report of disciplinary action, agreement, or order requiring participation in alternative programs or agreements which limit practice or require monitoring or dismissal of a complaint.

5. Changes to licensure information in the Information System shall be completed within ten (10) business days upon notification by a Board.

SECTION IV ENDORSEMENT

A. ELIGIBILITY

1. An applicant for licensure by endorsement must meet the requirements of the Board at the time of graduation.

2. An applicant licensed in another state after January 1950 must have taken a state board licensing examination and achieved a passing score.

3. LPTN applicants will be accepted from California and Kansas only.

4. Internationally educated nurses practicing in other states may appeal to the Board for licensure if not otherwise qualified.

5. An applicant for licensure by endorsement who has not been engaged in the active practice of nursing for a period greater than five (5) years shall document completion of the following:

a. Active practice of nursing for a minimum of one thousand hours (1,000) within the one year immediately prior to application. Verification of employment shall be submitted; or

b. Completion of a Arkansas board approved refresher course within one (1) year of the date of application; or

c. Graduation from an approved nursing education program, which required taking the licensure examination, within one year of the date of application.

d. Provide other evidence as requested by the Board.

B. EQUIVALENCIES

1. RN examination failures: Graduates of Board approved RN programs, holding LPN licensure by examination in other jurisdictions, may be endorsed provided they are otherwise qualified.

2. Canadian Registered Nurses licensed by NLN State Board Test Pool Examination in the following provinces during the years indicated: Alberta, 1952-1970; British Columbia, 1949-1970; Manitoba, 1955-1970; Newfoundland, 1961-1970; Nova Scotia, 1955-1970; Prince Edward Island, 1956-1970; Quebec (English language), 1959-1970; and Saskatchewan, 1956-1970. These applicants may be endorsed provided they are otherwise qualified.

3. Portion of RN Program: Candidates who have completed equivalent courses in a state approved program of nursing may be endorsed provided they are otherwise qualified. Evidence must be provided verifying successful completion of classroom instruction and clinical practice substantially similar to the minimum requirements for practical nursing programs.

C. APPLICATION

1. Applications must be completed and filed with the Board.

2. Endorsement certification will be accepted from the state of original licensure only.

3. Applicants for licensure by endorsement shall not be issued a permanent license to practice until such time that the results of the state and federal criminal background checks have been received.

D. FEE

1. The endorsement fee must accompany the application.

2. The fees for the state and federal criminal background checks are the responsibility of the applicant and shall be submitted to the Arkansas State Board of Nursing with the application for same.

3. The fees are not refundable.

SECTION V CRIMINAL BACKGROUND CHECK

A. No application for issuance of an initial license will be considered without state and federal criminal background checks by the Arkansas State Police and the Federal Bureau of Investigation.

B. Each applicant shall sign a release of information on the criminal background check application and licensure applications and shall be solely responsible for the payment of any fees associated with the state and federal criminal background checks.

C. Upon completion of the state and federal criminal background checks, the Identification Bureau of the Arkansas State Police shall forward all information obtained concerning the applicant in the commission of any offense listed in ACA § 17-87-312.

D. The state and federal criminal background checks conducted by the Arkansas State Police and the Federal Bureau of Investigation shall have been completed no earlier than twelve (12) months prior to the application for an initial license issued by the ASBN and at any other time thereafter that the Board deems necessary.

E. The ASBN shall not issue a permanent license until the state and federal criminal background checks conducted by the Arkansas State Police and the Federal Bureau of Investigation have been completed.

F. A request to seek waiver of the denial of licensure pursuant to the provisions of ACA § 17-87-312 may be made to the ASBN by:

1. The affected applicant for licensure; or

2. The person holding a license subject to revocation.

G. The request for a waiver shall be made in writing to the Executive Director or the designee within thirty (30) calendar days after notification of denial of a license. The request for waiver shall include, but not be limited to the following:

1. Certified copy of court records indicating grounds for conviction; and

2. Any other pertinent documentation to indicate surrounding circumstances.

H. If an individual notifies ASBN in writing that he or she desires a hearing regarding their request for a waiver, the ASBN will schedule the individual for a hearing pursuant to the Arkansas Administrative Procedures Act.

I. In compliance with ACA 17-87-312, whenever a criminal background check is performed on a person under the provisions of the criminal background check requirement contained in the Arkansas Code for licensure, the person may be disqualified for licensure if it is determined that the person committed a violation of any sexual offense formerly proscribed under ACA §§ 5-14-101 through 5-14-127 that is substantially equivalent to any sexual offense presently listed in Arkansas Code §§ 5-14-101 through 5-14-127 and is an offense screened for in a criminal background check.

SECTION VI TEMPORARY PERMITS

A. ENDORSEMENT AND EXAM APPLICANTS

1. ASBN shall be authorized to issue a temporary permit for a period not exceeding six months. This temporary permit shall be issued only to those applicants who meet all other qualifications for licensure by the ASBN.

2. The temporary permit shall immediately become invalid upon receipt of information obtained from the state or federal criminal background check indicating any offense listed in ACA § 17-87-312or upon notification to the applicant or ASBN of results on the first licensure examination he or she is eligible to take after the permit is issued.

3. Falsification of the applicant's criminal record history shall be grounds for disciplinary actionby the Board.

B. FEES AND APPLICATIONS

1. The temporary permit fee shall be submitted with the application.

2. The fee is not refundable.

SECTION VII CONTINUING EDUCATION

Each person holding an active license or applying for reinstatement of a license under the provisions of the Nurse Practice Act shall be required to complete certain continuing education requirements prior to licensure renewal or reinstatement.

A. DECLARATION OF COMPLIANCE

Each nurse shall declare his or her compliance with the requirements for continuing education at the time of license renewal or reinstatement. The declaration shall be made at the time of renewal.

B. AUDITS OF LICENSEES

1. The Board shall perform random audits of licensees for compliance with the continuing education requirement.

2. If audited, the licensee shall prove participation in the required continuing education during the 24 -months immediately preceding the renewal date by presenting photocopies of original certificates of completion to the Board.

3. The licensee shall provide evidence of continuing education requirements within thirty (30) calendar days from the mailing date of the audit notification letter sent from the Board to the last known address of the licensee.

C. CONTINUING EDUCATION REQUIREMENT STANDARDS

1. Standards for Renewal of Active Licensure Status. Licensees who hold an active nursing license shall document completion of one of the following during each renewal period:

a. Fifteen (15) practice focused contact hours from a nationally recognized or state continuing education approval body recognized by the ASBN; or

b. Certification or re-certification during the renewal period by a national certifying body recognized by the ASBN; or

c. An academic course in nursing or related field; and

d. Provide other evidence as requested by the Board.

e. Effective January 1, 2010, APNs with prescriptive authority shall complete five (5) contact hours of pharmacotherapeutics continuing education in the APN's area of certification each biennium prior to license renewal.

2. Standards for Nurses on Inactive Status. Nurses who have their license placed on inactive status have no requirements for continuing education.

3. Standards for Reinstatement of Active Licensure Status

a. Nurses reinstating a nursing license to active status after within five years or less shall document completion of the following within the past two (2) years:

i) Twenty (20) practice focused contact hours within the past two years from a nationally recognized or state continuing education approval body recognized by the ASBN, or

ii) Certification or re-certification by a national certifying body recognized by the ASBN; or

iii) An academic course in nursing or related field; and/or

iv) Provide other evidence as requested by the Board.

b. Nurses reinstating a nursing license to active status after greater than five (5) years shall document completion of the following:

i) Twenty (20) practice focused contact hours within the past two (2) years from a nationally recognized or state continuing education approval body recognized by the Arkansas State Board of Nursing, or

ii) Certification or re-certification by a national certifying body recognized by the ASBN; or

iii) An academic course in nursing or related field; and

iv) Active practice of nursing for a minimum of one thousand hours (1,000) within the one year immediately prior to application. Verification of employment shall be submitted; or

v) Completion of a Arkansas board approved refresher course within one (1) year of the date of application; or

vi) Graduation from an approved nursing education program, which required taking the licensure examination, within one (1) year of the date of application, and

vii) Provide other evidence as requested by the Board.

4. Standards for Reinstatement of Prescriptive Authority Effective January 1, 2010, APNs whose prescriptive authority is inactive shall complete five (5) contact hours of pharmacotherapeutics continuing education in the APN's area of certification for each twelve (12) months of non-prescribing activity in addition to the five (5) contact hours required for APN license renewal prior to reactivation of prescriptive authority.

5. The Board may issue a temporary permit to a nurse during the time enrolled in a Board approved nursing refresher course or an employer competency orientation program upon submission of an application, fees, and verification of enrollment in such program.

6. Continuing education hours beyond the required contact hours shall not be "carried over" to the next renewal period.

D. RESPONSIBILITIES OF THE INDIVIDUAL LICENSEE

1. It shall be the responsibility of each licensee to select and participate in those continuing activities that will meet the criteria for acceptable continuing education as specified in ACA § 17-87-207 and these rules.

2. It shall be the licensee's responsibility to maintain records of continuing education as well as documented proof such as original certificates of attendance, contact hour certificates, academic transcripts or grade slips and to submit copies of this evidence when requested by the Board.

3. Records shall be maintained by the licensee for a minimum of two consecutive renewal periods or four years.

E. RECOGNITION OF PROVIDERS

1. The Board shall identify organizations, agencies, and groups that shall be recognized as valid approval bodies/providers of nursing continuing education. The recognition may include providers approved by national organizations and state agencies with comparable standards.

2. The Board shall work with professional organizations, approved nursing schools, and other providers of continuing educational programs to ensure that continuing education activities are available to nurses in Arkansas.

F. ACTIVITIES ACCEPTABLE FOR CONTINUING EDUCATION

1. Activities presented by recognized providers which may be acceptable include: national/ regional educational conferences, classroom instruction, individualized instruction (home study/programmed instruction), academic courses, and institutional based instruction; and

2. The content shall be relevant to nursing practice and provide for professional growth of the licensee.

3. If participation is in an academic course or other program in which grades are given, a grade equivalent to "C" or better shall be required, or "pass" on a pass/fail grading system. An academic course may also be taken as "audit", provided that class attendance is verified by the instructor.

G. ACTIVITIES WHICH ARE NOT ACCEPTABLE AS CONTINUING EDUCATION

1. In-service programs. Activities intended to assist the nurse to acquire, maintain, and/or increase the competence in fulfilling the assigned responsibilities specific to the expectations of the employer.

2. Refresher courses. Programs designed to update basic general knowledge and clinical practice, which consist of a didactic and clinical component to ensure entry-level competencies into nursing practice.

3. Orientation programs. A program by which new staff are introduced to the philosophy, goals, policies, procedures, role expectations, physical facilities, and special services in a specific work setting. Orientation is provided at the time of employment and at other times when changes in roles and responsibilities occur in a specific work setting.

4. Courses designed for lay people.

H. INDIVIDUAL REVIEW OF A CONTINUING EDUCATION ACTIVITY PROVIDED BY A NON-RECOGNIZED A GENCY/ORGANIZATION

1. A licensee may request an individual review by:

a. Submitting an "Application for Individual Review"; and

b. Paying a fee.

2. Approval of a non-recognized continuing educational activity shall be limited to the specific event under consideration.

I. FAILURE TO COMPLY

1. Any licensee who fails to complete continuing education or who falsely certifies completion of continuing education shall be subject to disciplinary action, non-renewal of the nurse's license, or both, pursuant to ACA § 17-87-207 and A.C.A § 17-87-309(a)(l) and (a)(6).

2. If the Board determines that a licensee has failed to comply with continuing education requirements, the licensee will:

a. Be allowed to meet continuing education requirements within ninety (90) days of notification of noncompliance.

b. Be assessed a late fee for each contact hour that requirements are not met after the ninety (90) day grace period and be issued a Letter of Reprimand. Failure to pay the fee may result in further disciplinary action.

SECTION VII I RENEWALS

A. Each person licensed under the provisions of the Nurse Practice Act shall renew biennially.

1. Sixty (60) days prior to the expiration date, the Board shall mail a renewal notice to the last known address of each nurse to whom a license was issued or renewed during the current period.

2. The application shall be completed before the license renewal is processed.

3. The fee for renewal shall accompany the application.

4. The fee is not refundable.

5. Pursuant to Act 996 of 2003 and upon written request and submission of appropriate documentation, members of the Armed Forces of the United States who are Arkansas residents and are ordered to active duty to a duty station located outside of this state shall be allowed an extension without penalty or assessment of a late fee for renewing the service members nursing license. The extension shall be effective for the period that the service member is serving on active duty at a duty station located outside of this state and for a period not to exceed six months after the service member returns to the state.

B. LAPSED LICENSE

1. The license is lapsed if not renewed or placed in inactive status by the expiration date.

2. Failure to receive the renewal notice at the last address of record in the Board office shall not relieve the licensee of the responsibility for renewing the license by the expiration date.

3. Any licensee whose license has lapsed shall file a renewal application and pay the current renewal fee and the late fee.

4. Any person practicing nursing during the time his or her license has lapsed shall be considered an illegal practitioner and shall be subject to the penalties provided for violation of the Nurse Practice Act.

C. INACTIVE STATUS

1. Any licensee in good standing, who desires to retire temporarily from the practice of nursing in this state, shall submit a request in writing and the current license shall be placed on inactive status.

2. While inactive, the licensee shall not practice nursing nor be subject to the payment of renewal fees.

3. When the licensee desires to resume practice, he or she shall request a renewal application, which shall be completed and submitted with a reinstatement fee and the renewal fee and must meet those requirements outlined in Section VII.

4. When disciplinary proceedings have been initiated against an inactive licensee, the license shall not be reinstated until the proceedings have been completed.

D. RETIRED NURSE

1. Any licensee in good standing, who desires to retire for any length of time from the practice of nursing in this state, shall submit a request in writing, and pay the required fee. and The current license shall be placed on inactive status and a retired license issued.

2. A retired license shall be renewed biennially following submission of a renewal application and fee.

3. Fees are non-refundable.

4. While retired, the licensee shall not practice nursing, however:

a. A registered nurse with a retired license may use the title "Registered Nurse", or the abbreviation "RN"; and

b. A practical nurse with a retired license may use the title "Licensed Practice Nurse", or the abbreviation "LPN'; and

c. A psychiatric technician nurse with a retired license may use the title "Licensed Psychiatric Technician Nurse", or the abbreviation "LPTN".

5. When the licensee desires to resume practice, he or she shall request a renewal application, which shall be completed and submitted with a reinstatement fee and the active renewal fee. The licensee must also meet those requirements outlined in Section VII.

6. If the retired license is allowed to lapse, the licensee shall not hold himself or herself out as an RN, LPN, or LPTN and shall pay a reinstatement fee in addition to the fee required for renewal of the retired license.

7. When disciplinary proceedings have been initiated against a retired licensee, the license shall not be reinstated until the proceedings have been completed.

E. The licensee may be required to submit to a state and federal criminal background check if the Board deems it necessary.

SECTION IX DUPLICATE LICENSE

A duplicate license or certificate shall be issued when the licensee submits a statement to the Board that the document is lost, stolen, or destroyed, and pays the required fee.

SECTION X CERTIFICATION/VERIFICATION TO ANOTHER JURISDICTION

Upon payment of a certification/verification fee, a nurse seeking licensure in another state may have a certified statement of Arkansas licensure issued to the Board of Nursing in that state.

SECTION XI NAME OR ADDRESS CHANGE

A. A licensee, whose name is legally changed, shall be issued a replacement license following submission of the current license, along with a notarized statement, copy of marriage license, or court action, and the required fee.

B. A licensee, whose address changes from the address on file with the Board, shall immediately notify the Board in writing of the change.

CHAPTER THREE REGISTERED NURSE PRACTITIONER

SECTION I SCOPE OF PRACTICE

A. REGISTERED NURSE PRACTITIONER

A registered nurse practitioner is a licensed professional nurse prepared in the manner stated herein who provides direct care to individuals, families, and other groups in a variety of settings, including homes, hospitals, offices, industry, schools, and other institutions and health care settings. The service provided by the nurse practitioner is directed toward the delivery of primary, secondary, and tertiary care which focuses on the achievement and maintenance of optimal functions in the population. The nurse practitioner engages in independent decision making about the nursing care needs of clients and collaborates with health professionals and others in making decisions about other health care needs. The practitioner plans and institutes health care programs as a member of the health care team. The nurse practitioner is directly accountable and responsible to the recipient for the quality of care rendered.

Rules which apply to registered nurses are hereby incorporated by reference.

B. ACTS PROPER TO BE PERFORMED BY A REGISTERED NURSE PRACTITIONER

1. The Arkansas State Board of Nursing authorizes the registered nurse practitioner, in collaboration with and under the direction of a licensed physician, to perform particular acts at the advanced and specialized levels as recognized by the nursing profession and which are in conformity with the Nurse Practice Act.

a. Secures, records, and evaluates the health psychosocial, and developmental history of patients;

b. Performs physical examinations using techniques of observation, inspection, auscultation, palpation and percussion, and uses appropriate diagnostic tests;

c. Discriminates between normal and abnormal findings on the history and physical examination and refers the individuals who need further evaluation or supervision;

d. Documents the processes of nursing care delivery;

e. Contributes to the comprehensive care of the ill in collaboration with the health care team.

f. Coordinates health care plans to enhance the quality of health care and diminish both fragmentation and duplication of service;

g. Contributes to the health education of individuals and groups and applies methods designed to increase each person's motivation to assume responsibility for his own health care;

h. Facilitates entry into and through the health care system by appropriate route;

i. Counsels with families and/or individuals regarding family planning, pregnancy, child care, emotional stresses, long term illness, and general health problems;

j. Performs periodic health evaluations and plans for health maintenance of clients; and

k. Conducts community clinics for case finding and screening for health problems.

2. The Arkansas State Board of Nursing authorizes the registered nurse practitioner, in collaboration with and under the direction of a licensed physician, to perform particular acts recognized by the nursing profession and which are in conformity with the Nurse Practice Act.

a. Assumes responsibility for ongoing health maintenance and clinical management of stable chronically ill patients;

b. Provides initial care of emergencies and initiates arrangements for continuing definitive care;

c. Identifies, manages, and initiates treatment for common medical problems by "Protocols" as described in Section I.C.; and

d. Evaluates progress and manages prenatal and postpartum care.

C. PROTOCOLS

1. Any nurse practicing as a registered nurse practitioner shall practice in accordance with protocols developed in collaboration with and signed by a licensed physician.

2. Protocols shall address:

a. Established procedures for the management of common medical problems in the practice setting;

b. The degree to which collaboration, independent action, and supervision are required; and c. Acts including, but not limited to, assessment, diagnosis, treatment, and evaluation.

3. Protocols shall not include controlled substances.

4. Documentation.

a. Orders transmitted from protocols shall be documented on the client's medical record;

b. Orders transmitted from protocols to inpatient medical records shall contain:

(1) Name of medication, therapeutic device, or treatment;

(2) Strength;

(3) Dose;

(4) Length of time or amount prescribed;

(5) Directions for use;

(6) RNP Signature; and

(7) Physician's name, printed, followed by notation "protocol."

5. Any deviation from written protocols shall require:

a. A specific written or verbal order from the collaborating physician before the order is transmitted or implemented; and

b. Documentation in the medical record as specified in lb. (l)-(6) above, and notation that order was by consultation, to be signed by the RNP.

6. Review of Protocols

a. The RNP shall document annual joint review with the licensed physician, and revise when necessary.

b. The RNP shall, upon request, provide the Board with current protocols.

7. Nothing in this regulation shall be construed to prohibit any registered nurse practitioner from transmitting a prescription order orally or telephonically, or from administering a legend drug pursuant to a lawful direction of a licensed physician, dentist, or advanced practice nurse who holds a certificate of prescriptive authority.

D. SERVICES AND RESPONSIBILITIES

The RNP shall, upon request of the Board, provide documentation outlining the extent of services, responsibilities, and required supervision of nurse practitioners, and the accompanying responsibilities of collaborating physicians.

E. DELEGATED ACTS

The registered nurse practitioner shall demonstrate competence in any act or procedure delegated by the collaborating physician.

SECTION II LICENSURE

A. Initial licensing of registered nurse practitioners terminated on November 30, 2000.

B. RENEWAL

1. The date for renewal of licensure to practice as a registered nurse practitioner shall coincide with the renewal of the applicant's registered nurse license.

2. An application for renewal of a registered nurse practitioner license shall submit to the Board:

a. A completed application form; and

b. Payment of the nonrefundable renewal fee.

C. LAPSED LICENSE

1. The license is lapsed if not renewed or placed in an inactive status by the expiration date.

2. Failure to receive the renewal notice shall not relieve the licensee of the responsibility for renewing the license by the expiration date.

3. Any licensee whose license has lapsed shall submit to the Board:

a. A completed Board renewal application form; and

b. The renewal fee and the reinstatement fee.

4. Fees are nonrefundable.

5. Any person practicing as a registered nurse practitioner during the time his or her license has lapsed shall be considered an illegal practitioner and shall be subjected to the penalties provided for violation of the Nurse Practice Act.

D. INACTIVE STATUS

1. Any licensee in good standing who desires his or her registered nurse practitioner license to be placed on inactive status may submit a request in writing to the Board.

2. The current license shall be placed on inactive status.

3. While the license is inactive, the licensee shall not engage in registered nurse practitioner nursing nor be subject to the payment of renewal fees.

4. If the nurse desires to resume practice, he or she shall submit a written request for a renewal application, which shall be completed and submitted with a renewal fee and the reinstatement fee.

5. Fees are nonrefundable.

6. If disciplinary proceedings on an inactive licensee have been initiated, the license shall not be reinstated until the proceedings have been completed.

SECTION III DUPLICATE LICENSE

A. The licensee shall immediately report a lost, stolen, or destroyed license to the Board.

B. A duplicate license shall be issued when the licensee submits a notarized statement to the Board that the document is lost, stolen, or destroyed, and pays the required fee.

SECTION IV NAME OR ADDRESS CHANGE

A. A licensee whose name is legally changed shall be issued a replacement license following submission of the current license, along with an affidavit, copy of marriage license or court action, and the required fee.

B. A licensee, whose address changes from the address on file with the Board, shall immediately notify the Board in writing of the change.

CHAPTER FOUR ADVANCED PRACTICE REGISTERED NURSE

SECTION I SCOPE OF PRACTICE

The advanced practice registered nurse (APRN) shall practice in a manner consistent with the definition of the practice of advanced practice nursing set forth in Arkansas Code Annotated § 17-87-102(4).(A)(B)(C)(D), and in accordance with the scope of practice existing by the appropriate national certifying body and the standards set forth in these rules. The Board specifically approves and incorporates into these rules the scope of practice established and existing from time to time by those national certifying bodies which the Board has approved for APRNs. The advanced practice registered nurse (APRN) may provide health care for which the APRN is educationally prepared and for which competence has been attained and maintained.

SECTION II QUALIFICATIONS FOR LICENSURE

Advanced practice registered nurse (APRN) licensure shall be designated in one of the four roles below and at least one population focus; Family/Individual Across the Lifespan, Adult-Gerontology, Neonatal, Pediatrics, Women's Health/Gender-related, or Psychiatric/Mental Health (effective 2015). A current, unencumbered registered nurse license to practice in Arkansas is required for all categories of advanced practice licensure. Effective January 1, 2003, all applicants for advanced practice licensure by examination shall have completed a graduate or post-graduate level advanced practice nursing education program. Applicants for advanced practice licensure by endorsement shall have met the educational and certification requirements set forth in Arkansas State Board of Nursing Rulesat the time of their initial licensure as an advanced practice registered nurse in another jurisdiction. APRN roles and their respective qualifications are:

A. CERTIFIED NURSE PRACTITIONER (CNP)

1. Successful completion of a nationally accredited graduate or post-graduate APRN education program that prepares nurses for the advanced practice role of certified nurse practitioner; and

2. . Hold current certification by a national certifying body recognized by the Board of Nursing in the APRN role and population foci appropriate for educational preparation.

B. CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)

1. Successful completion, of a nationally accredited graduate or post-graduate APRN education program that prepares nurses to perform as nurse anesthetists; and

2. Hold current certification by a national certifying body recognized by the Board of Nursing in the APRN role and population foci appropriate for educational preparation.

C. CERTIFIED NURSE MIDWIFE (CNM)

1. Successful completion of a nationally accredited graduate or post-graduate APRN education program that prepares nurses for the advanced practice role of nurse midwife; and

2. Hold current certification by a national certifying body recognized by the Board of Nursing in the APRN role and population foci appropriate for educational preparation.; and

3. Written agreement with a consulting physician if providing intrapartum care.

D. CLINICAL NURSE SPECIALIST (CNS)

1. Successful completion of a nationally accredited graduate or post-graduate APRN education program that prepares nurses for the advanced practice role of clinical nurse specialist which shall include supervised clinical practice and classroom instruction in a nursing clinical practice specialty; and

2. Hold current certification by a national certifying body recognized by the Board of Nursing in the APRN role and population foci appropriate for educational preparation.

SECTION III LICENSURE

A. ELIGIBILITY

The applicant shall meet the licensure requirements of the Board.

B. APPLICATION FOR LICENSURE BY EXAMINATION

In addition to a current registered nurse license to practice in Arkansas, the information submitted to the Board shall include:

1. A completed Board application form;

2. An official transcript or document from a nursing education program accredited by a nursing accrediting body that is recognized by the U.S. Secretary of Education and/or Council for higher Education Accreditation (CHEA), as acceptable by the Board and meets the qualifications of Section II of this Chapter in the category of advanced practice nursing for which the applicant is seeking licensure. The transcript or document shall verify the date of graduation, the degree or certificate conferred, clinical hours completed, and the role and population focus of the education program;

3. Evidence of state and federal criminal background checks conducted by the Arkansas State Police and the Federal Bureau of Investigation completed no earlier than twelve (12) months prior to the application for advanced practice licensure;

4. A statement directly from the Board approved national certifying body evidencing current certification in good standing; and

5. Payment of the nonrefundable fee.

C. APPLICATION FOR LICENSURE BY ENDORSEMENT

1. The Board may issue a license by endorsement to an APRN licensed under the laws of another state if, in the opinion of the Board, the applicant meets the qualifications for licensure in this state.

2. In addition to the requirements set forth in Section II and III.

A. and

B. of this Chapter, the information submitted to the Board shall include documentation of current unencumbered advanced practice licensure/authority to practice in another jurisdiction.

3. An individual applying for licensure by endorsement who has been out of practice for more than two (2) years shall provide evidence of passing an APRN nursing refresher course approved by the board or an extensive orientation in the appropriate advanced practice role and population focus which includes a supervised clinical component by a qualified preceptor who meets the following requirements:

a. Holds an active unencumbered APRN or physician license.

b. Is in current practice in the advanced role and population focus and

c. Functions as a supervisor and teacher and evaluates the individual's performance in the clinical setting.

D. APPLICATION FOR AN INTERNATIONALLY EDUCATED APRN (educated outside the United States)

An internationally educated applicant for licensure in this state as an APRN shall:

1. Graduate from a graduate level APRN program equivalent to an APRN educational program in the United States accepted by the board.

2. Submit an official transcript directly from the international nursing education program and verified through a qualified credentials evaluation process for the license being sought.

3. Meet all other licensure criteria required of applicants educated in the United States, including English proficiency.

E. TEMPORARY PERMITS

1. Upon application and payment of the required fee, the Board shall issue a temporary permit to practice in an advanced practice nursing category to a qualified applicant who has no violations as listed in ACA § 17-87-312 on the Arkansas State Police criminal background check and:

a. Meets the educational requirements set forth in Section II of this Chapter and has been accepted by the appropriate certification body to sit for the first national certification exam he or she is eligible to take; or

b. Has a current advanced practice license or the equivalent from another jurisdiction and has current Board approved certification in the appropriate advanced practice nursing education category.

2. The temporary permit shall immediately become invalid upon receipt of information obtained from the federal criminal background check indicating any offense listed in ACA § 17-87-312 or upon notification to the applicant or ASBN of failure of the certification examination.

3. The temporary permit is not renewable and does not apply to prescriptive authority.

4. In no event shall the permit be valid in excess of six (6) months.

F. RENEWALS

1. The date for renewal of licensure to practice as an advanced practice registered nurse shall coincide with renewal of the applicant's registered nurse license.

2. An applicant for renewal of an advanced practice registered nurse license shall submit to the Board:

a. A completed Board renewal application form;

b. Documentation of current national certification in the appropriate APRN specialty through an maintenance program of a Board approved certifying body;

c. Documentation of current compact state RN licensure if primary state of residence has enacted the Interstate Nurse Licensure Compact; and

d. Payment of the nonrefundable renewal fee.

3. Advanced practice registered nurses with prescriptive authority shall submit evidence of a current collaborative practice agreement as a prerequisite to license renewal.

4. If disciplinary proceedings have been initiated against an individual with a lapsed, inactive, or retired license, the license shall not be renewed until the proceedings have been completed.

5. Continuing education submitted to the certifying body to meet the qualifications for recertification shall be accepted as meeting the statutory requirement for continuing education.

6. Upon request, an APRN shall submit documentation to the Board of continuing education.

7. Effective January 1, 2010, APRNs with prescriptive authority shall complete five (5) contact hours of pharmacotherapeutics continuing education in the APN' s area of certification each biennium prior to license renewal.

G. LAPSED APRN LICENSE

The license is lapsed if not renewed or placed in an inactive status by the expiration date.

1. The license is lapsed if the RN license or privilege to practice in Arkansas is not current.

2. The license is lapsed when the national certification upon which licensure was granted expires.

3. Failure to receive the renewal notice shall not relieve the licensee of the responsibility for renewing the license by the expiration date.

4. Any licensee whose license has lapsed shall submit to the Board:

a. A completed Board renewal application form;

b. Documentation of current national certification; and

c. The renewal fee and the reinstatement fee/late penalty.

5. Fees submitted to the Board are nonrefundable.

6. Any person engaged in advanced practice nursing during the time his or her license has lapsed shall be considered an illegal practitioner and shall be subject to the penalties provided for violation of the Nurse Practice Act.

H. REINSTATEMENT OF APRN LICENSE

1. An individual who applies for licensure reinstatement who has been out of practice for more than two (2) years shall provide evidence of passing an APRN nursing refresher course approved by the board or an extensive orientation in the appropriate advanced practice role and population focus which includes a supervised clinical component by a qualified preceptor who meets the following requirements:

a. Holds an active unencumbered APRN or physician license

b. Is in current practice in the advanced role and population focus

c. Functions as a supervisor and teacher and evaluates the individual's performance in the clinical setting

2. For those licensees applying for licensure reinstatement following disciplinary action, compliance with all board licensure requirements as well as any specified requirements set forth in the board's discipline order is required.

I. INACTIVE STATUS

1. Any licensee in good standing who desires his or her advanced practice license to be placed on inactive status may submit a request in writing to the Board.

2. The APRN license shall immediately be placed on inactive status when the registered nurse license is placed on inactive or retired status.

3. The current license shall be placed on inactive status upon receipt of the written request.

4. While the license is inactive, the licensee shall not engage in advanced practice nursing nor be subject to the payment of renewal fees.

5. If the nurse desires to resume practice in this state, he or she shall request a renewal application, which shall be completed and submitted with a renewal fee and the reinstatement fee. Fees are nonrefundable.

6. All certification and continuing education requirements for renewal shall apply.

J. RETIRED ADVANCED PRACTICE REGISTERED NURSE

1. Any advanced practice registered nurse in good standing whose registered nurse license has been placed on retired status may request that their APRN license be placed on retired status.

2. The APRN shall submit a request in writing, and pay the required fee. and the current license shall be placed on inactive status and a retired APRN license issued.

3. An APRN retired license shall be renewed biennially following submission of a renewal application and fee.

4. Fees are non-refundable.

5. While retired, the APRN shall not practice nursing, however, an advanced practice registered nurse with a retired license may use the title 'Advanced Practice Registered Nurse" or the abbreviation "APRN."

6. When the licensee desires to resume practice, he or she shall request a renewal application, which shall be completed and submitted with a reinstatement fee and the active renewal fee. The licensee must also meet those requirements outlined in Section III.E.

7. If the retired APRN license is allowed to lapse, the licensee shall not hold himself or herself out as an APRN and shall pay a reinstatement fee in addition to the fee required for renewal of the retired APRN license.

K. ADDITIONAL CERTIFICATIONS

1. An APRN who has completed post-masters education for an additional nursing specialty shall:

a. Submit a request for permission to practice in the new certification area;

b. Submit a copy of authorization to sit for the first available certification exam from the Board approved certifying body;

c. Immediately cease practicing in the specialty upon notification of failure of the exam;

d. Submit results of the certification in the additional specialty directly from the certifying body;

e. Submit an official transcript or document from a nursing education program that meets the qualifications in Section II of this Chapter verifying the date and degree or certificate conferred.

2. An APRN who has prescriptive authority shall:

a. Prescribe only for patients covered by the original specialty while waiting additional specialty results.

b. Submit a collaborative practice agreement which includes the additional certification.

SECTION IV DUPLICATE LICENSE

A duplicate license or certificate shall be issued when the licensee submits a notarized statement to the Board that the document is lost, stolen, or destroyed, and pays the required fee.

SECTION V NAME OR ADDRESS CHANGE

A. A licensee whose name is legally changed shall be issued a replacement license following submission of the current license, along with an affidavit, copy of marriage license or court action, and the required fee.

B. A licensee whose address changes from the address on file with the Board shall immediately notify the Board in writing of the change.

SECTION VI STANDARDS OF NURSING PRACTICE

A. PURPOSE

1. To establish standards essential for safe practice by the advanced practice registered nurse.

2. To serve as a guide for evaluation of advanced nursing registered practice.

B. STANDARDS FOR ALL CATEGORIES OF ADVANCED PRACTICE REGISTERED NURSING

1. The advanced practice registered nurse shall assess clients at an advanced level, identify health status including abnormal conditions, establish a diagnosis, develop and implement treatment plans and evaluate client outcomes.

2. The advanced practice registered nurse shall use advanced knowledge and skills in teaching and guiding clients and other health team members.

3. The advanced practice registered nurse shall use critical thinking and decision making at an advanced level, commensurate with the autonomy, authority, and responsibility of his/her practice category.

4. The advanced practice registered nurse shall have knowledge of the statutes and rules governing advanced nursing practice, and function within the legal boundaries of the appropriate advanced practice nursing category.

5. The advanced practice registered nurse shall recognize the APRN 's limits of knowledge and experience, planning for situations beyond expertise, and collaborating with or referring clients to other health care providers as appropriate.

6. The advanced practice registered nurse shall retain professional accountability for advanced practice nursing care when delegating interventions.

7. The advanced practice registered nurse shall maintain current knowledge and skills in the advanced practice nursing category.

8. Rules which apply to registered nurses are hereby incorporated by reference.

9. The APRN shall comply with the standards for registered nurses as specified in Chapter I L Standards for a specific role and population focus of APRN supersede standards for registered nurses where conflict between the standards, if any, exists.

C. In addition to the standards, the advanced practice registered nurse shall practice in accordance with the standards established by the national certifying body from which the APRN holds his or her certification required for licensure. These standards shall have been reviewed and accepted by the Board.

D. ADDITIONAL STANDARDS FOR CRNAs

1. The CRNA, acting in the normal course of his/her professional practice, may be authorized by a hospital or institution to act as their agent or employee to order the administration of controlled substances under the DEA registration of the hospital or institution.

2. The CRNA may order nurses to administer drugs preoperatively and/or postoperatively in connection with an anesthetic and/or other operative or invasive procedure that will be or has been provided.

3. The CRNA's order shall be directly related to the administration of drugs preoperatively and/or postoperatively in connection with an anesthetic and/or other operative or invasive procedure that will be or has been provided.

4. A CRNA who has not been granted authority by a DEA registrant as described in Title 21 CFR 1301.22, or its successor to order the administration of controlled substances shall give all orders as verbal orders from the supervising physician, dentist, or other person lawfully entitled to order anesthesia.

5. The CRNA shall be responsible for complying with all applicable state and federal laws and rules related to medications.

SECTION VII PROFESSIONAL CERTIFICATION PROGRAMS

A. A national certification program which meets the following criteria shall be recognized by the Board to satisfy Section II of these rules.

B. The national certification program:

1. Is national in the scope of its credentialing;

2. Is accredited by a national accreditation body as acceptable by the Board;

3. Has no requirement for an applicant to be a member of any organization;

4. Has an application process and credential review which includes documentation that the applicant's education is in the advanced practice nursing category being certified, and that the applicant's clinical practice is in the certification category;

5. Education requirements are consistent with the requirements of the advanced practice role and population foci.

6. Uses an examination as a basis for certification in the advanced practice nursing category which meets the following criteria:

a. The examination is based upon job analysis studies conducted using standard methodologies acceptable to the testing community;

b. The examination represents entry-level practice in the APRN role and population focus;

c. The examination represents the knowledge, skills, and abilities essential for the delivery of safe and effective advanced nursing care to clients;

d. The examination content and its distribution are specified in a test plan (blueprint), based on the job analysis study, that is available to examinees;

e. Examination items are reviewed for content validity and correct scoring using an established mechanism, both before use and periodically;

f. Examinations are evaluated for psychometric performance;

h. The passing standard is established using acceptable psychometric methods, and is reevaluated at least every five (5) years;

i. Examination security is maintained through established procedures; and

j. A re-take policy is in place.

7. Issues certification based upon passing the examination and meeting all other certification requirements;

8. Provides for periodic recertification which includes review of continued education, qualifications, and continued competence;

9. Has mechanisms in place for communication to the Board for timely verification of an individual's certification status, changes in certification status, and changes in the certification program, including qualifications, test plan, and scope of practice;

10. Has an evaluation process to provide quality assurance in its certification program.

C. The Board will notify the appropriate certifying body when an APRN has any disciplinary action taken on their license or privilege to practice.

SECTION VIII PRESCRIPTIVE AUTHORITY

A. INITIAL APPLICANT

An applicant for an initial certificate of prescriptive authority shall:

1. Be currently licensed as an advanced practice registered nurse in Arkansas.

2. Provide evidence from the national certifying body that differential diagnosis and prescribing practices are recognized as being within the scope of practice for the applicant's certification category.

3. Provide documentation of successful completion of pharmacology coursework which shall include pharmacokinetics principles and their clinical application and the prescription of pharmacological agents in the prevention and treatment of illness, and the restoration and maintenance of health. The coursework shall contain a minimum of:

a. Three (3) graduate credit hour pharmacology course offered by an accredited college or university within two years immediately prior to the date of application to the Board; or

b. Forty-five (45) contact hours [a contact hour is fifty (50) minutes] in a pharmacology course which includes a competency component, offered by an accredited college or university, within two (2) years immediately prior to the date of application to the Board; or

c. Three (3) graduate credit hours pharmacology course, included as part of an advanced practice nursing education program, within five (5) years immediately prior to the date of application to the Board.

4. Provide documentation of a minimum of three hundred (300) clock hours preceptorial experience in the prescription of drugs, medicines and therapeutic devices with a qualified preceptor, to be initiated with the pharmacology course and to be completed within one year of the beginning of the course. Preceptorial experience completed as a part of the formal educational program in which the pharmacology course is taught will meet the three hundred (300) clock hour requirement.

5. Submit a current collaborative practice agreement with a physician who is licensed under the Arkansas Medical Practices Act, § 17-95-201 et seq., and who has a practice comparable in scope, specialty or expertise to that of the advanced practice registered nurse. APRNs who will prescribe controlled substances shall seek a collaborative practice with a physician who has an unrestricted DEA registration number. The collaborative practice agreement shall include, but not be limited to:

a. Availability of the collaborating physician(s) for consultation or referral or both;

b. Methods of management of the collaborative practice, which shall include the use of protocols for prescriptive authority;

c. Plans for coverage of the health care needs of a client in the emergency absence of the advanced practice registered nurse or physician;

d. Provision for quality assurance; and

e. Signatures of the advanced practice registered nurse and collaborating physician(s), signifying mutual agreement to the terms of the collaborative practice.

6. Submit the nonrefundable processing fee with the application for a certificate of prescriptive authority.

B. ENDORSEMENT APPLICANT

1. An applicant for endorsement of prescriptive authority shall:

a. Provide documentation of a three (3) graduate credit hour pharmacology course offered by an accredited college or university or a forty-five (45) contact hour [a contact hour is fifty (50) minutes] pharmacology course which includes a competency component offered by an accredited college or university;

b. Provide evidence that prescriptive authority is current and unencumbered in the jurisdiction from which the applicant is moving;

c. Provide evidence of prescribing in a clinical setting for at least 500 hours in the year prior to application for a certificate of prescriptive authority;

d. Have an unencumbered advanced practice registered nursing license to practice or the equivalent in the jurisdiction from which the applicant is moving;

e. Provide a copy of current DEA registration (if prescriber has DEA number) and history of registration status; and

f Meet requirements in Section VIII.A. 1,2,5,6.

2. Endorsement applicants who do not meet all requirements established herein shall be required to submit documentation acceptable to the Board according to Section VIII. A.

C. PROTOCOLS FOR PRESCRIPTIVE AUTHORITY

Protocols shall be made available upon request of the Board. Such protocols shall, at a minimum, include:

1. Indications for and classifications of legend drugs, controlled substances (if prescriber holds a DEA registration number), and therapeutic devices which will be prescribed or administered by the APRN;

2. Date the protocol was adopted or last reviewed, which shall be at least annually.

D. PRESCRIBING PRIVILEGES

1. The APRN, applying for a certificate of prescriptive authority, shall acknowledge in the application that he or she is familiar with all state and federal laws and rules regarding prescribing, and shall agree to comply with these laws and rules.

2. An advanced practice registered nurse with a certificate of prescriptive authority may receive and prescribe legend drugs, medicines or therapeutic devices appropriate to the APRN's area of practice. The prescriptive authority for controlled drugs shall only extend to drugs listed in Schedules III through V.

3. Prescribing stipulations are as follows:

a. Legend drugs, therapeutic devices, and controlled substances (Schedules III-V), defined by the state and/or federal controlled substances lists, will be prescribed, administered, or ordered as established in protocols provided that the APRN has an assigned DEA registration number which is entered on each written prescription for a controlled substance.

b. The APRN shall file his/her DEA registration number with the Board upon receipt.

c. Advanced practice registered nurses shall not delegate to unlicensed ancillary staff the calling in of prescriptions to the pharmacy.

d. The APRN shall notify the Board in writing within thirty (30) days following termination of the collaborative practice agreement. A new collaborative practice agreement is required to be on file prior to reactivating prescriptive authority.

4. The APRN may prescribe a legend drug, medicine or therapeutic devices not included in the written protocols only as follows:

a. Upon a specific written or verbal order obtained from the collaborating physician before the prescription or order is issued by the APRN; and

b. Include documentation of consultation as described above in the client's medical record to be signed by the APRN;

c. Schedules I and II controlled substances shall not be prescribed under the APRN 's certificate of prescriptive authority.

5. The APRN shall note prescriptions on the client's medical record and include the following information:

a. Medication and strength;

b. Dose;

c. Amount prescribed;

d. Directions for use;

e. Number of refills; and

f Initials or signature of APRN.

6. Advanced practice registered nurses in the category of certified registered nurse anesthetists shall not be required to have prescriptive authority to provide anesthesia care, including the administration of drugs or medicines necessary for such care.

7. Advanced practice registered nurses who prescribe prior to obtaining a certificate of prescriptive shall be considered illegal practitioners and shall be subject to the penalties provided for violation of the Nurse Practice Act.

E. PRESCRIPTION FORMAT

1. All prescriptions issued by the APRN shall contain the name of the client, and the APRN 's name, title, address, telephone number, signature with the initials " APRN ", and shall include information contained in Subsection D.5.a-f of this Section.

2. All prescriptions for controlled substances shall be in accordance with federal rules. The APRN's assigned DEA registration number shall be included on the prescription when a controlled substance is prescribed.

F. RECEIVING PREPACKAGED DRUG SAMPLES

1. APRNs who have fulfilled requirements for prescriptive authority may receive legend drug samples and therapeutic devices appropriate to their area of practice, including controlled substances contained in Schedules III through V of the Controlled Substance Act, which have been prepared, packaged, or fabricated by a pharmaceutical manufacturer in accordance with the Arkansas pharmacy laws and rules.

2. Records must comply with all applicable federal and state laws and rules.

G. TERMINATION OF PRESCRIPTIVE AUTHORITY

1. Prescriptive authority may be terminated by the Board when the prescriber:

a. Fails to maintain current active licensure as an advanced practice registered nurse;

b. Violates provisions of this Act and/or rules established by the Arkansas Department of Health Nursing, or Pharmacy Boards;

c. Violates any state or federal law or rules applicable to prescriptions; or

d. Fails to follow any conditions imposed.

2. To reinstate prescriptive authority, the APRN must meet requirements of the Board at the time of reinstatement.

H. LAPSED CERTIFICATE OF PRESCRIPTIVE AUTHORITY

1. The certificate of prescriptive authority is lapsed if:

a. The licensee's active advanced practice registered nurse license is not renewed by the expiration date;

b. The national certification upon which licensure is based expires;

c. There is not a current collaborative practice agreement on file with the board; or

d. The advanced practice license is placed in inactive or retired status.

2. After reinstating a lapsed advanced practice license, the licensee shall submit to the Board a current collaborative practice agreement to reactivate the certificate of prescriptive authority.

3. Any person engaged in prescribing during the time his or her certificate of prescriptive authority has lapsed shall be considered an illegal practitioner and shall be subject to the penalties provided for violation of the Nurse Practice Act.

I. INACTIVE STATUS

1. A certificate of prescriptive authority will automatically be considered lapsed and subject to the requirements of these rules when a licensee places his or her advanced practice license on inactive status.

2. While the certificate of prescriptive authority or advanced practice registered nurse license is inactive the licensee shall not engage in any practice within the scope of the certificate of prescriptive authority.

3. If the nurse desires to resume practice in this state, he or she shall request a renewal application which shall be completed and submitted with a renewal fee and the reinstatement fee. Fees are nonrefundable.

4. All certification requirements for renewal shall apply.

5. If disciplinary proceedings on an inactive licensee have been initiated, the license shall not be reinstated until the proceedings have been completed.

6. Effective January 1, 2010, APRN s whose prescriptive authority is inactive shall complete five (5) contact hours of pharmacotherapeutics continuing education in the APRN's area of certification for each 12 months of non-prescribing activity in addition to the five (5) contact hours required for APRN license renewal prior to reactivation of prescriptive authority.

SECTION IX PRESCRIBING GUIDELINES FOR ANOREXIANT DRUGS

An Advanced Practice Registered Nurse (APRN') must maintain prescribing medication practices that are within the APRN's educational preparation and certification. An APRN will be in violation of the Arkansas Nurse Practice Act if he/she prescribes Schedule III and/or Schedule IV drugs under the Uniform Controlled Substance Act for short-term treatment of obesity, except in conformity with the requirements as set below.

A. PRESCRIBING GUIDELINES

1. An established APRN/patient relationship shall exist. The patient shall be age 18 or older, or have written consent from a parent or guardian. The medication shall only be an adjunct to a comprehensive weight loss program focused on appropriate nutrition education, a change in lifestyle, counseling, and an individualized exercise program. The APRN shall determine whether or not the patient has made a substantial good faith effort to lose weight through diet and alteration of lifestyle prior to beginning drug therapy.

2. The treating APRN shall take a complete history of the patient, including a detailed family history, dietary history, and shall perform a complete physical examination. The physical examination shall include a minimum of checking the blood pressure and pulse, examining the heart and lungs, recording height and weight, and administering any other appropriate diagnostic tests to evaluate for a metabolic disorder. The history and examination shall be sufficient to determine if the patient has previously been drug dependent, to determine if there is a metabolic cause of the obesity which would make anorexiant drugs inappropriate, and to determine if there are other contraindications to use of anorexiant drugs exists.

3. The APRN shall discuss with the patient different approaches to the treatment of obesity, and the risks and benefits associated with each approach. Risks shall include potential side effects, such as cardiovascular and pulmonary complications, as well as the potential for lack of success with weight loss. The APRN shall be aware of potential drug interactions between anorexiants, and other centrally acting drugs. The treating APRN shall prescribe a diet for weight loss and appropriate counseling regarding lifestyle change, and record these changes on the patient's medical record. Consideration on the use of anorexiant medications shall take into account the degree of overweight and associated medical conditions. The body mass index (BMI) shall be used as a guide to determine the degree of overweight status. In general, anorexiant medications shall only be used if the BMI is more than 27. In the case of associated obesity-related medical conditions, anorexiant medications may be considered with a BMI above 25. Obesity-related medical conditions include, but are not limited to. diabetes, hypertension, dyslipidemia. cardiovascular disease, sleep apnea, psychological conditions, disc disease, and severe arthritis of the lower extremities.

4. The treating APRN shall prescribe a daily dosage that does not exceed the dosage recommended in the manufacturer's prescribing information for the drug prescribed.

5. The APRN shall not prescribe more than a 30-day supply for a patient at each visit and regular follow-up visits shall not exceed 30 days. The patient shall be weighed at each visit prior to the prescribing of an additional supply of the drug.

6. At the time of each return patient visit, the treating APRN shall monitor progress of the patient. The patient's weight, blood pressure, pulse, heart, and lungs shall be assessed. In addition to any side effects of the medications, the APRN shall perform appropriate exams and tests to monitor the safety of any weight loss. This may include a detailed dietary questionnaire, serum electrolytes, blood glucose, and other tests deemed appropriate. The APRN shall discontinue the anorexiant medications when the patient reaches weight loss goals. These goals may be defined as a body weight that is no longer considered "obese" (e.g. BMI of less than or equal to 27), or an improvement in medical conditions (e.g. normalization of blood glucose). After the goal is reached, the APRN may continue to prescribe anorexiant drugs for up to an additional sixty (60) days.

7. Except as otherwise provided by this regulation. Schedule III and/or Schedule IV anorexiant drugs are only recommended for short-term use (e.g. 90 days). In addition, anorexiant drugs shall not be prescribed to a patient with a BMI of less than 27. unless prescribing for obesity-related conditions with a BMI of above 25. The treating APRN may extend therapy beyond 90 days under the following conditions:

a. When the anorexiant drugs are indicated for treatment of diseases other than obesity; and

b. When, in the APRN's professional judgment, the treating APRN is assessing and recording significant progress or benefit from the drugs and no adverse effects occur that are related to the treatment.

SECTION X PRESCRIPTIVE AUTHORITY ADVISORY COMMITTEE

A. PURPOSE

The purpose of this committee shall include functioning in an advisory capacity to assist the Board with oversight and implementation of the provisions regarding prescriptive authority.

B. COMPOSITION

The Advisory Committee shall be composed of six (6) members appointed by the Board and approved by the Governor. Four members shall be advanced practice registered nurses with at least three (3) holding a certificates of prescriptive authority and an active PEA number. One (1) committee member shall be a licensed physician who has been involved in a collaborative practice with an advanced practice registered nurse for at least five (5) years. One member shall be a licensed pharmacist who has been licensed for at least five (5) years.

C. TERMS OF OFFICE

Members shall serve three (3) year terms and may be reappointed. The Board may remove any advisory committee member, after notice and hearing, for incapacity, incompetence, neglect of duty, or malfeasance in office.

D. COMPENSATION

Advisory committee members shall serve without compensation; but may be reimbursed to the extent special monies are appropriated therefore for actual and necessary expenses incurred in the performance of their official Board duties.

SECTION XI NURSING EDUCATION PROGRAMS

A. NEW APRN PROGRAM LEADING TO LICENSURE

1. Prerequisite Approval

a. An institution, seeking to establish a new APRN nursing education program leading to licensure, shall submit a letter of intent to the Board.

(1) An applicant for an Advanced Practice Registered Nursing (APRN) program shall comply with the "Criteria and Procedures for Preparing Proposals for New Programs," established by the Arkansas Department of Higher Education.

(2) Appropriate professional accreditation (nursing accrediting organizations recognized by the U. S. Department of Education and/or the Council for Higher Education Accreditation) of the new APRN program is considered to be deemed status as approved by the Board.

b. The institution shall submit:

(1) A copy of the curricula plan and course descriptions for Board review within thirty (30) days of sending the information to the accrediting body;

(2) Other accreditation materials as requested by the Board; and

(3) Documentation of accreditation within thirty (30) days of receipt of the report from the accrediting body.

B. ESTABLISHED PROGRAM THAT PREPARES GRADUATES FOR LICENSURE

1. Continued Full Approval

a. An established graduate program in advanced practice registered nursing shall submit to the Board documentation of the program's continued national nursing accreditation status within thirty (30) days of receipt from the accrediting body. Receipt of the documentation shall serve as deemed status for approval by the ASBN.

C. EDUCATION PROGRAM

1. The education program for advanced practice nursing shall meet the nursing accrediting body standards for advanced practice registered nursing.

2. The curriculum plan for advanced practice nursing shall include:

a. Preparation in one of the four identified APRN roles (CRNA, CNM, CNS, and ACNP); and

b. Preparation in at least one of the approved population foci: (effective 2015)

(1) Family/Individual Across the Lifespan

(2) Adult-Gerontology

(3) Neonatal

(4) Pediatrics

(5) Women's Health/Gender-related

(6) Psychiatric/Mental Health; and

c. Three separate graduate level courses (the APRN Core):

(1) Advanced physiology and pathophysiology

(2) Advanced health assessment

(3) Advanced pharmacology

3. Clinical Experiences

a. All graduate or post-graduate programs leading to advanced practice licensure shall have a minimum of 500 supervised clinical hours in direct clinical practice during the program.

b. APRN programs preparing for two population foci shall have a minimum of 500 supervised clinical hours for each population focus.

c. Clinical supervision must be congruent with current national professional organizations and nursing accrediting body standards applicable to the APRN role and population focus.

d. Student clinical experiences shall be congruent with the population focus of the role.

CHAPTER SIX STANDARDS FOR NURSING EDUCATION PROGRAMS

SECTION I APPROVAL OF PROGRAMS

This chapter presents the Standards established by the Arkansas State Board of Nursing for nursing education programs that lead to practical nursing and registered nursing licensure.

A. NEW PROGRAM LEADING TO LICENSURE

1. Institution Requirement

a. A nursing education program whose parent institution is located in an Arkansas jurisdiction seeking to establish a new baccalaureate, diploma, associate degree or practical nursing program shall meet the following requirements:

(1) Educational institutions or consortiums shall be approved by the Arkansas Department of Higher Education and be accredited by an accrediting body recognized by the United States Secretary of Education.

(2) Hospitals or hospital consortiums shall be approved by the Arkansas Department of Health and accredited by the Joint Commission on Accreditation of Health Care Organizations.

(3) The proposed program must have an affiliation with a current Arkansas State Board of Nursing approved program that is in good standing.

(4) The parent institution shall meet the transfer or articulation requirements for courses in Arkansas education institutions.

b. A nursing education program whose parent institution is located outside of Arkansas jurisdiction seeking to establish a new baccalaureate, diploma, associate degree or practical nursing program shall meet the following requirements:

(1) Education institutions shall be approved by the Arkansas department of Higher Education and be accredited by an accrediting body recognized by the United States Secretary of Education.

(2) Be approved/accredited by the Board of Nursing or equivalent agency in the state where the parent institution originates.

(3) Show evidence of a continuing affiliation with a current Arkansas State Board of Nursing approved program that is in good standing.

(4) The parent institution shall meet the transfer or articulation requirements for courses in Arkansas education institutions.

(5) Maintain the Education Standards required of Arkansas based nursing education programs.

2. Prerequisite Approval

a. An institution seeking to establish a new nursing education program leading to licensure shall submit a letter of intent to the Board at least one year prior to submission of proposal.

b. The institution must submit a current feasibility study, that is signed by the appropriate administrative officers, and includes the following:

(1) Purpose for establishing the program;

(2) Type of educational program to be established;

(3) Copy of affiliation agreement with current ASBN nursing program;

(4) Relationship to the parent institution, including an organizational chart;

(5) Mission, philosophy, purposes, and accreditation status of the parent institution;

(6) Financial statement of the parent institution for the past two fiscal years;

(7) A proposed budget for each year of the program's implementation;

(8) Documented need and readiness of the community to support the program, including surveys of potential students, employment availability, and potential employers;

(9) Source and numbers of potential students and faculty;

(10) Proposed employee positions including support staff;

(11) Proposed clinical facilities for student experiences, including letters of support from all major facilities expected to be used for full program implementation, including evidence of clinical space for additional students;

(12) Letters of support from approved nursing and health-related programs using the proposed clinical facilities;

(13) Proposed physical facilities including offices, classrooms, technology, library, and laboratories;

(14) Availability of the general education component of the curriculum or letter of agreement, if planned, from another institution; and

(15) A timetable for initiating the program, including required resources, and plans for attaining initial approval.

(16) Other information as requested by the Board.

c The Board shall review all prerequisite documents and may determine the need for an on-site survey during a regularly scheduled Board meeting.

d. The Board may grant, defer, or deny Prerequisite Approval.

e. If the Board denies Prerequisite Approval the program must wait two years before submitting another proposal.

f. After receiving Prerequisite Approval status, the institution may:

(1) Advertise for students; and

(2) Proceed toward compliance by following the Education Standards for Initial Approval.

3. Initial Approval

a. The institution shall secure a nurse administrator of the program.

b. The nurse administrator shall plan the program and

(1) Assure compliance with Board standards and recommendations;

(2) Address prerequisite recommendations;

(3) Prepare detailed budget;

(4) Employ qualified faculty and support staff;

(5) Prepare a program organizational chart showing lines of authority;

(6) Design the program's sequential curriculum plan;

(7) Develop student, faculty, and support staff policies and procedures;

(8) Attain agency affiliation agreements;

(9) Verify that proposed physical facilities are in place; and

(10) Submit documentation to the Board that Initial Approval Standards are met.

c. A Board representative shall validate readiness of the program to admit students and prepare a report.

d. The Board shall review all documents for Initial Approval during a regularly scheduled Board meeting.

e. The Board may grant, defer or deny Initial Approval,

f. After receiving Initial Approval, the program:

(1) May admit students;

(2) Shall proceed toward compliance by following the Education Standards for Full Approval; and

(3) Shall follow the same standards as those of established programs in terms of annual activities, projects, and reports.

(4) Full Approval

a. Before graduation of the first class, a Board representative shall validate compliance with the Standards and prepare a report.

b. The report and documentation shall be reviewed during a regularly scheduled Board meeting.

c. The Board may grant, defer, or deny Full Approval.

B. ESTABLISHED PROGRAM THAT PREPARES GRADUATES FOR PRACTICAL AND REGISTERED NURSING LICENSURE

1. Continued Full Approval

a. A survey shall be periodically conducted to review the program for continued compliance with the Standards. An on-site or paper survey for a program includes:

(1) A newly established program shall have an on-site survey three (3) years after receiving initial Full Approval.

(2) An established professional or practical nurse program that has continued accreditation status with a national nursing accreditation organization and has maintained a NCLEX-RN® or NCLEX-PN® pass rate of at least 75% shall have a paper survey every five (5) years thereafter.

(3) An established professional or practical nurse program that does not meet the criteria for accreditation with a national nursing education accreditation organization or has failed to maintain at least a 75% pass rate on the NCLEX-RN® or NCLEX-PN® shall have an on site survey visit every five (5) years thereafter.

b. The survey report and documentation shall be submitted to the Board and reviewed during a regularly scheduled Board meeting.

c. The Board may grant, defer, or deny Continued Full Approval.

2. Conditional Approval

a. If areas of noncompliance with standards are not corrected in the timeframe established by the Board, the Board shall award Conditional Approval.

b. Information regarding a nursing program requested by the Board shall be provided by the parent institution.

c. A representative of the Board shall conduct an on-site survey and complete a written report.

d. Additional information available to the Board may be considered.

e. The Board shall review all documents during a regularly scheduled Board meeting.

f. The Conditional Approval status shall be in effect for a maximum of one (1) year to correct noncompliance deviations from the standards, unless otherwise determined by the Board.

g. The program and parent institution shall receive written notification of noncompliance deviations and the Board action.

h. The Board may grant continued Conditional Approval, Full Approval, or withdraw the program's approval.

3. Satellite Campus

a. Satellite campus programs shall be approved by the Board prior to implementation.

(1) Continued Full Approval program may submit a proposal for a satellite campus program.

(2) The proposal shall reflect requirements for prerequisite approval of a new program.

b. The Board may grant, defer, or deny approval.

c. All approved satellite campus programs shall maintain the same standards as the parent program.

d. Each satellite campus' data will be included in the program's annual report and five-year survey report.

4. Distant Learning Sites

a. Distant learning sites shall be approved by the Board prior to utilization.

b. Each distant learning site's data shall be included in the program's annual report and five-year survey report.

SECTION II PROGRAM REQUIREMENTS

A. ADMINISTRATION AND ORGANIZATION

1. Institutional Accreditation

The parent institution shall be approved by the appropriate state body.

2. Institutional Organization

a. The parent institution shall be a post-secondary educational institution, hospital, or consortium of such institutions.

b. The institutional organizational chart shall indicate lines of authority and relationships with administration, the program, and other departments.

c. The program shall have at least equal status with comparable departments of the parent institution.

3. Program Organization

a. The program shall have a current organizational chart.

b. The program shall have specific current job descriptions for all positions.

B. PHILOSOPHY AND GRADUATE COMPETENCIES

1. The philosophy of the program shall be in writing and consistent with the mission of the parent institution.

2. Graduate competencies shall be derived from the program's philosophy.

3. The philosophy and graduate competencies shall serve as the framework for program development and maintenance.

C. RESOURCES

1. Financial Resources

a. There shall be adequate financial support to provide stability, development, and effective operation of the program.

b. The director of the program shall administer the budget according to parent institutional policies.

c. The director shall make budget recommendations with input from the faculty and staff.

2. Library and Learning Resource Center

a. Each program and each satellite campus shall have a library or learning resource center with the following:

(1) Current holdings to meet student educational needs, faculty instructional needs, and scholarly activities.

(2) Budget plan for acquisitions of printed and multi-media materials.

(3) Written process for identifying and deleting outdated holdings.

(4) Resources and services accessible and conveniently available.

b. The library of a baccalaureate, diploma, associate degree, or practical nurse program shall be under the direction of a qualified master's degreed librarian.

D. FACILITIES

1. Classrooms and Laboratories

a. Each program and satellite campus shall have a clinical skills laboratory equipped with necessary educational resources.

b. Classrooms and laboratories shall be:

(1) Available at the scheduled time;

(2) Adequate in size for number of students;

(3) Climate controlled, ventilated, lighted; and

(4) Equipped with seating, furnishings and equipment conducive to learning and program goals.

c. Adequate storage space shall be available.

d. Facilities shall be in compliance with applicable local, state, and federal rules and regulations related to safety and the Americans with Disabilities Act.

2. Offices

a. The director of the program shall have a private office.

b. Faculty members shall have adequate office space to complete duties of their positions and provide for uninterrupted work and privacy for conferences with students.

c. There shall also be adequate:

(1) Office space for clerical staff;

(2) Secure space for records, files, equipment, and supplies; and

(3) Office equipment and supplies to meet the needs of faculty and clerical staff.

3. Clinical Facilities

a. Clinical facilities and sites shall provide adequate learning experiences to meet course objectives.

b. Clinical sites shall be adequately staffed with health professionals.

c. The program shall have a current and appropriate written agreement with each clinical site.

d. Written agreements shall include a termination clause and be reviewed annually.

e. Students shall receive orientation to each clinical site.

E. PERSONNEL

1. Program Director

a. The program director shall have a current unencumbered registered nurse license to practice in Arkansas and be employed full time.

b. The practical nursing program director shall have a minimum of a baccalaureate degree in nursing. Directors appointed prior to January 1, 2004, shall be exempt for the duration of their current position.

c. The baccalaureate, diploma or associate degree program director shall have a minimum of a master's degree in nursing.

d. The program director shall have previous experience in clinical nursing practice and/or education.

e. The program director's primary responsibility and authority shall be to administer the nursing program.

(1) The program director shall be accountable for program administration, planning, implementation, and evaluation.

(2) Adequate time shall be allowed for relevant administrative duties and responsibilities.

f. The licensure examination application shall be authorized by the nursing program director to assure the applicant has completed the program.

2. Faculty and Assistant Clinical Instructors

a. Faculty shall hold a current unencumbered registered nurse license to practice in Arkansas.

b. Faculty shall have had at least one year's previous experience in clinical nursing at or above the education program level.

c. Faculty teaching in a baccalaureate, diploma, associate degree, or practical nurse program shall have a degree or diploma above the type of education program offered.

d. Nurses serving as assistant clinical instructors in a baccalaureate, diploma, associate degree, or practical nurse program may shall have a degree or diploma at or above the type of education program offered.

e. Assistant clinical instructors shall:

(1) Be under the direction of faculty;

(2) Hold a current unencumbered license to practice in Arkansas; and

(3) Have a minimum of one year experience in the clinical area.

f All faculty shall maintain education and clinical competencies in areas of instructional responsibilities.

g. Non-nurse faculty shall meet the requirements of the parent institution.

h. Faculty shall be organized with written policies, procedures, and, if appropriate, standing committees.

i. Nursing faculty policies shall be consistent with parent institutional policies.

j. Program specific policies shall be developed by nursing faculty.

k. A planned program specific orientation for new faculty shall be in writing and implemented.

l. Consideration shall be given to safety, patient acuity, and the clinical area in determining the necessary faculty to student ratio for clinical experiences. The faculty to student ratio in clinical experiences shall be no greater than 1:10. Effective January 1,2015, the faculty to student ratio in clinical experiences shall be:

(1) In the acute care setting where students are providing direct patient care the ratio is one faculty member to eight students (1:8).

(2) In the non-acute care setting where students are providing direct patient care the ratio is one faculty member to ten students (1:10).

(3) In the community setting where the students have indirect patient care with a community partner the ratio is one faculty member to fifteen students (1:15).

m. The minimum number of faculty shall be one (1) full-time member in addition to the director,

n. Faculty meetings shall be regularly scheduled and held. Minutes shall be maintained in writing,

o. Faculty members shall participate in program activities as per policies and procedures.

3. Support Staff

There shall be secretarial designated support staff sufficient to meet the needs of the program.

F. PRECEPTORS

1. Preceptor Utilization

a. Preceptors shall not be utilized in foundation or introductory courses.

b. Preceptors shall not be considered in clinical faculty-student ratio. The ratio of preceptor to student shall not exceed 1:2.

c. There shall be written policies for the use of preceptors, that include:

(1) Communications between the program and preceptor concerning students;

(2) Duties, roles, and responsibilities of the program, preceptor, and student; and

(3) An evaluation process.

d. All preceptors shall be listed on the annual report by area, agency, and number of students precepted.

2. Preceptor Criteria

a. Baccalaureate, diploma, associate degree, or practical nurse program student preceptors shall hold a current unencumbered license to practice as a registered nurse in Arkansas. Practical nurse student preceptors shall hold a current unencumbered license to practice as a registered nurse, licensed practical nurse, or licensed psychiatric technician nurse in Arkansas.

b. Preceptors shall have a minimum of one-year experience in the area of clinical specialty for which the preceptor is utilized.

c. Preceptors shall participate in evaluation of the student.

3. Student Criteria

a. Precepted students shall be enrolled in courses specific to the preceptor's expertise.

b. Precepted students shall have appropriate learning experiences prior to the preceptorship.

c. There shall be no reimbursement to students for the educational preceptorship.

4. Faculty Criteria

a. Program faculty shall be responsible for the learning activity.

b. Program faculty shall be available for consultation with student and preceptor.

c. Program faculty shall be responsible for the final evaluation of the experience.

G. STUDENTS

1. Admissions, Readmissions, and Transfers a. There shall be written policies for admission, readmission, transfer, and advanced placement of students.

b. Admission criteria shall reflect consideration of potential to complete the program and meet standards to apply for licensure (See ACA § 17-87-312).

c. Students who speak English as a second language shall meet the same admission criteria as other students and shall pass an English proficiency examination.

d. Documentation of high school graduation or an equivalent, as determined by the appropriate educational agency, shall be an admission requirement.

2. Progression and Graduation: There shall be written policies for progression and graduation of students.

3. Student Services

a. Academic and financial aid services shall be accessible to all students.

b. If health services are not available through the parent institution, a plan for emergency care shall be in writing.

c. There shall be provision for a counseling and guidance program separate from nursing faculty.

4. Appeal Policies: Appeal policies shall be in writing and provide for academic and non-academic grievances.

5. Program Governance: Students shall participate in program governance as appropriate.

H. STUDENT PUBLICATIONS

1. Publications shall be current, dated, and internally consistent with parent institution and program materials.

2. The following minimum information shall be available in writing for prospective and current students:

a. Approval status of the program granted by the Board;

b. Admission criteria;

c. Advanced placement policies;

d. Curriculum plan;

e. Program costs; f Refund policy;

g. Financial aid information; and

h. Information on meeting eligibility standards for licensure, including information on ACA § 17-87-312 and that graduating from a nursing program does not assure ASBN's approval to take the licensure examination.

3. The student handbook shall include the following minimum information:

a. Philosophy and graduate competencies;

b. Policies related to substance abuse, processes for grievances and appeal, grading, progression, and graduation; and

c. Student rights and responsibilities.

I. EDUCATIONAL PROGRAM

1. The education program shall include curriculum and learning experiences essential for the expected entry level and scope of practice.

a. Curriculum development shall be the responsibility of the nursing faculty.

b. Curriculum plan shall be organized to reflect the philosophy and graduate competencies.

c. Courses shall be placed in a logical and sequential manner showing progression of knowledge and learning experiences.

d. Courses shall have written syllabi indicating learning experiences and requirements.

e. Theory content shall be taught concurrently or prior to related clinical experience,

f Clinical experiences shall include expectations of professional conduct by students,

g. Curriculum plans for all programs shall include appropriate content in:

(1) Introduction to current federal and state patient care guidelines;

(2) Current and emerging infectious diseases;

(3) Emergency preparedness for natural and manmade disasters;

(4) Impact of genetic research and cloning;

(5) End of life care; and

(6) Legal and ethical aspects of nursing, including the Arkansas Nurse Practice Act.

2. The curriculum plan for practical nurse programs shall include:

a. Theoretical content and clinical experiences that focus on:

(1) Care for persons throughout the life span including cultural sensitivity;

(2) Restoration, promotion, and maintenance of physical and mental health; and

(3) Prevention of illness for individuals and groups.

b. The length of the practical nurse curriculum shall be no less than ten (10) calendar months which includes a minimum of thirty-five (35) credit hours in nursing content.

c. Theory content may be in separate courses or integrated and shall include at least the following:

(1) Anatomy and physiology;

(2) Nutrition;

(3) Pharmacology and intravenous therapy;

(4) Growth and development throughout the life span;

(5) Fundamentals of nursing;

(6) Gerontological nursing;

(7) Nursing of adults;

(8) Pediatric nursing;

(9) Maternal/infant nursing;

(10) Mental health nursing; and

(11) Principles of management in long term care, including delegation.

d. Clinical experiences shall be in the areas of:

(1) Fundamentals of nursing;

(2) Nursing of adults;

(3) Pediatric nursing;

(4) Gerontological nursing;

(5) Maternal/infant nursing;

(6) Mental health;

(7) Administration of medications, including intravenous therapy; and

(8) Management in long term care, including delegation.

3. The curriculum plan for baccalaureate, diploma, or associate degree nurse programs shall include:

a. Theoretical content and clinical experiences that focus upon:

(1) The prevention of illness and the restoration, promotion, and maintenance of physical and mental health;

(2) Nursing care based upon assessment, analysis, planning, implementing, and evaluating; and

(3) Care for persons throughout the life span, including cultural sensitivity,

b. Course content may be in separate courses or integrated and shall include at least the following:

(1) Biological and physical sciences content:

a. Chemistry;

b. Anatomy and physiology;

c. Microbiology;

d. Pharmacology;

e. Nutrition; and

f. Mathematics.

(2) Behavioral science and humanities content:

a. Psychology;

b. Sociology;

c. Growth and Development;

d. Interpersonal relationships;

e. Communication; and

f. English composition.

(3) Nursing science content:

a. Medical surgical adult;

b. Pediatrics;

c. Maternal/Infant;

d. Gerontology;

e. Mental Health;

f Leadership, including nursing management and delegation; and

g. Baccalaureate programs shall include community health.

(4) Clinical experiences shall be in the areas of:

a. Medical/surgical;

b. Pediatrics;

c. Maternal/infant;

d. Mental health;

e. Gerontology;

f. Leadership and management, including delegation;

g. Rehabilitation; and

h. Baccalaureate programs shall include clinical in community health,

J. PROGRAM EVALUATION

1. Faculty shall be responsible for program evaluation.

2. A systematic evaluation plan of all program aspects shall be in writing, implemented, and include: philosophy and graduate competencies, curriculum, policies, resources, facilities, faculty, students, graduates, and employer evaluation of graduates.

3. The outcomes of the systematic evaluations shall be used for ongoing maintenance and development of the program.

4. Appropriate records shall be maintained to assist in overall evaluation of the program after graduation.

5. The systematic program evaluation plan shall be periodically reviewed.

6. Students shall evaluate the courses, instructors, preceptors, and clinical experiences throughout the program, and the overall program after graduation.

K. RECORDS

1. Transcripts of all students enrolled in the program shall be maintained according to policies of the parent institution.

a. Transcripts shall reflect courses taken.

b. The final transcript shall include:

(1) Dates of admission;

(2) Date of separation or graduation from the program;

(3) Hours/credits/units earned, degree, diploma, or certificate awarded;

(4) The signature of the program director, registrar, or official electronic signature; and

(5) The seal of the school or be printed on security paper or an official electronic document.

c. Current program records shall be safely stored in a secure area.

d. Permanent student records shall be safely stored to prevent loss by destruction and unauthorized use.

SECTION III REPORTS, LICENSURE EXAMINATION PERFORMANCE, AND CLOSURE

A. REPORTS

1. Annual report: An annual report shall be submitted in a format and date determined by the Board.

2. Special reports/requests: The Board shall be notified in writing of major changes affecting the program, including but not limited to:

a. School name;

b. Director of Program; and

c. Ownership or merger of parent institution.

3. Curriculum changes:

a. Baccalaureate, diploma, associate degree, or practical nurse program changes - Major changes of curriculum or standards shall be reported to the Board prior to implementation, including but not limited to:

(1) Philosophy, competencies, and objectives.

(2) Reorganization of curriculum.

(3) Increase or decrease in length of program.

b. Practical Programs - Major changes of curriculum and standards shall be approved prior to implementation, including but not limited to:

(1) Philosophy, competencies, and objectives;

(2) Reorganization of curriculum; and

(3) Increase or decrease in length of program.

4. Pilot programs/projects that differ from the current approved program shall be approved prior to implementation.

B. LICENSURE EXAMINATION PERFORMANCE

1. The student pass rate on the licensure examination shall be calculated on the ASBN fiscal year.

2. The program shall maintain a minimum pass rate of 75% for first-time examination candidates.

3. Any program with a pass rate below 75% shall:

a. First year:

(1) Receive a letter of concern; and

(2) Provide the Board with a report analyzing all aspects of the program. The report shall identify and analyze areas contributing to the low pass rate and include plans for resolution which shall be implemented.

b. Second consecutive year:

(1) Receive a letter of warning; and

(2) Program director and parent institution representative shall present a report to the Board. The report shall identify and analyze the failure of first year corrections and additional plans for resolution of the low pass rate.

c. Third consecutive year:

(1) Be placed on conditional approval; and

(2) Conditional approval will be granted until two consecutive years of an above 75% pass rate is achieved or until the Board withdraws approval status for noncompliance with the education standards.

C. PROGRAM CLOSURE

1. Voluntary

a. The parent institution shall submit a letter of intent for closure at least six (6) months prior to the closure. The letter shall include:

(1) Date of closure; and

(2) Plan for completion of currently enrolled students.

b. The Board must approve closure plan prior to implementation.

c. All classes and clinical experiences shall be provided until current students complete the program or parent institution provides for transfer to another acceptable program.

d. Records of a closed program shall be maintained by the parent institution and be in compliance with federal and state laws. The institution shall notify the Board of arrangements for the storage of permanent student and graduate records.

2. Mandatory

a. Upon Board determination that a program has failed to comply with educational standards and approval has been withdrawn, the parent institution shall receive written notification for closure of the program. The notification shall include:

(1) The reason for withdrawal of approval;

(2) The date of expected closure; and

(3) A requirement for a plan for completion of currently enrolled students or transfer of students to another acceptable program.

b. Records of a closed program shall be maintained by the parent institution and be in compliance with federal and state laws. The institution shall notify the Board of arrangements for the storage of permanent student and graduate records.

3. A program that has had withdrawal of their approval status may apply as a new program after one year from official closure date.

(12/21/2012)

The following state regulations pages link to this page.